Part A

Ref no.: 25008178 PSCDEB1-D2C-BlueDart-1822649-1886095-NHNI

30405310611

Ms. POOJA RANA

17th June 2022
A-485,STREET NO 16,PART-4
ZERO PUSTA,SONIA VIHAR
SABHAPU
ASHRAM KSHETRA
C

Delhi 110094
Delhi
Tele.Nos - 8130180514
Mobile No : 918130180514
India
R

Dear Ms. POOJA RANA,

Sub: Your Policy no. 25008178
We are glad to inform you that your proposal has been accepted and the HDFC Life Sanchay Fixed Maturity Plan (“ Policy”) being this
document, has been issued. We have made every effort to design your Policy Document in a simple format. We have highlighted items of
importance so that you may recognize them easily.

Policy document:
As an evidence of the insurance contract between HDFC Life Insurance Company Limited and you, the Policy is enclosed herewith. Please
preserve this document safely and also inform your Nominees about the same. A copy of your proposal form and other relevant documents
submitted by you are also enclosed for your information and record.

Cancellation in the Free-Look Period:

In case you are not agreeable to any of the terms and conditions stated in the Policy, you have the option to return the Policy to us for
cancellation stating the reasons thereof, within 30 days from the date of receipt of the Policy as your Policy is an electronic Policy / purchased
through Distance Marketing mode. On receipt of your letter along with the original Policy (original Policy Document is not required for policies
in dematerialised form), we shall arrange to refund the Premium paid by you, subject to deduction of the proportionate risk Premium for the
period of cover and the expenses incurred by us for medical examination (if any) and stamp duty charges.

Contacting us:
The address for correspondence is specified below. To enable us to serve you better, you are requested to quote your Policy number in all
future correspondence. In case you are keen to know more about our products and services, we would request you to talk to our Certified
Financial Consultant (Insurance Agent) who has advised you while taking this Policy. The details of your Certified Financial Consultant
including contact details are listed below. In case you are keen to know more about our products and services, please call us on our toll-free
number 1800 266 9777 or email us @ onlinequery@hdfclife.in. You can also get in touch with us via social media:

https://www.youtube.com/user/hdfclife10
http://www.linkedin.com/company/19117
https://twitter.com/HDFClife
https://www.facebook.com/HDFClife

To contact us in case of any grievance, please refer to Part G. In case you are not satisfied with our response, you can also approach the
Insurance Ombudsman in your region. Thanking you for choosing HDFC Life Insurance Company Limited and looking forward to serving you
in the years ahead,
Yours sincerely,

Authorised Signatory
Branch Address:HDFC Life Delhi-Rohini-Sec-3 B, 3rd floor 301 Plot 15 N N Mall, Mangalam Place District Center,Rohini Sector 3,
Delhi, 110085
Agent details
Name : Mr. NAVEEN KUMAR SAHANI, Address : AMRENDRA KUMAR SAHANI
BARWAN, KHURD BARWA KHURD SIWAN, BASANTPUR BIHAR 841406, SIWAN,
Bihar - Agent No. : 01160341 License No. : HDF 01160341 Contact Details :8707016426
8707016426

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PSCDEB1-D2C-BlueDart-1822649-1886095-NHNI
Address for Correspondence : HDFC Life Insurance Company Limited, 11th Floor Lodha Excelus, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai-
400011.

Registered Office : HDFC Life Insurance Company Limited, Lodha Excelus, 13th Floor, Apollo Mills Compound, Mahalaxmi, Mumbai-400011. Call 1860-267-9999
(local charges apply). DO NOT prefix any country code e.g. +91 or 00. Available Mon-Sat from 10 am to 7 pm | Email – service@hdfclife.com |
NRIservice@hdfclife.com (For NRI customers only) Visit – www.hdfclife.com. CIN: L65110MH2000PLC128245.Helpline number: 18602679999 (Local charges
apply)

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PSCDEB1-D2C-BlueDart-1822649-1886095-NHNI
 POLICY DOCUMENT- HDFC Life Sanchay Fixed Maturity Plan

Unique Identification Number:101N142V01

Your Policy is a non-linked, non-participating, individual, savings, life insurance plan. This document is the evidence of a contract
between HDFC Life Insurance Company Limited and the Policyholder as described in the Policy Schedule given below. This Policy is
based on the proposal made by the within named Policyholder and submitted to the Company along with the required documents,
declarations, statements, any response given to medical questionnaire by the Life Assured, applicable medical evidence and other
information received by the Company from the Policyholder, Life Assured or on behalf of the Policyholder (“Proposal”)This Policy is
effective upon receipt and realisation, by the Company, of the consideration payable as First Premium under the Policy. This Policy is
written under and will be governed by the applicable laws in force in India and all Premiums and Benefits are expressed and payable
in Indian Rupees.

POLICY SCHEDULE
Policy number:25008178
Client ID:NV552147

Policyholder Details

Name Ms. POOJA RANA

A-485,STREET NO 16,PART-4
ZERO PUSTA,SONIA VIHAR SABHAPU
ASHRAM KSHETRA
Address Delhi
Delhi
110094

Details of Second Life Assured in case of

Life Assured 1 Details
Joint Life cover
Name Ms. POOJA RANA NA
A-485,STREET NO 16,PART-4, ZERO
Address PUSTA,SONIA VIHAR SABHAPU, ASHRAM
KSHETRA, Delhi, Delhi - 110094

Date of Birth 9th December 1990 NA

Age on the Date of Risk
31 Years NA
Commencement
Age Admitted Yes NA

Policy Details
Type of Coverage Single Life Coverage
Date of Risk Commencement 27th May 2022
Date of Issue/Inception of Policy 15th June 2022

Premium Due Date(s) 27th May

Death Benefit Multiple for 1st Life 10.0000

Assured
Death Benefit Multiple for 2nd Life NA
Assured
Guaranteed Maturity Multiple 13.5256

Sum Assured on Maturity ` 405,768.00

Sum Assured on Death ` 210,000.00

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PSCDEB1-D2C_BlueDart-1822649-1886095
Death Benefit First Death (at ` 300,000.00
inception of the policy)
Death Benefit - Second Death – 1st
Life Assured (at inception of the NA
policy)
Death Benefit - Second Death – 2nd
Life Assured (at inception of the NA
policy)
Annualized/ Single Premium ` 30,000.00

Policy Term 15 years

Premium Paying Term Limited 7 years

Frequency of Premium Payment Annual

Premium per Frequency of ` 30,000.00
Premium Payment
Underwriting Extra Premium per
` 0.00
Frequency of Premium Payment
Total Premium per Frequency of ` 30,112.00
Premium Payment
Grace Period 30 days

Final Premium Due Date 27/05/2028

Maturity Date 27/05/2037

Policy issued on the basis of No
medical questionnaire
The Premium amount is excluding any applicable taxes and levies applicable on the Premium. Amount of taxes and levies will be charged at
actuals as per prevalent rate.

HDFC Life Insurance Company Limited

11th Floor, Lodha Excelus,
Apollo Mills Compound,
Address for Communication N. M. Joshi Road,
Mahalaxmi,
Mumbai - 400 011.
Email: service@hdfclife.com

Stamp Duty of ` 81.20/- is paid as provided under Article 47D(iii) of Indian Stamp
Act, 1899 and included in Consolidated Stamp Duty Paid to the Government of
Maharashtra Treasury vide Order of Addl. Controller Of Stamps, Mumbai at
General Stamp Office, Fort, Mumbai - 400001., vide this Order
No.(LOA/CSD/359/2022/Validity Period Dt.06/06/2022 To
Dt.31/03/2023(O/w.No.2397)/Date :06/06/2022)'

Proper Officer

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PSCDEB1-D2C_BlueDart-1822649-1886095
Rider Policy Details

Name of the Rider HDFC Life Critical Illness Plus Rider

UIN of the Rider 101B014V02

Date of Risk Commencement 27th May 2022

Date of Issue 15th June 2022

Rider Sum Assured 100,000.00

Annualized Premium / Single
112.00
Premium
Policy Term 7 years

Premium Paying Term 7 years

Frequency of Premium Payment Annual

Premium per Frequency of
112.00
Premium Payment

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PSCDEB1-D2C-BlueDart-1822649-1886095
 HDFC Life Critical Illness Plus Rider
UIN:101B014V02
Part B
Definitions
In this Rider document, the following definitions shall be applicable:
1) Benefit - means the Critical Illness Benefit provided as per terms and conditions
mentioned under this Rider;
2) Company, company, Insurer, Us, us, We, we, Our, our - means or refers to HDFC
Life Insurance Company Limited;
3) Critical Illness(es) - The Critical Illnesses covered under this Rider are as follows:
S. Definitions of Critical Illnesses
Name of
N ii. Where only islets of langerhans are transplanted
Disease
o
A malignant tumor characterized by the uncontrolled growth
and spread of malignant cells with invasion and destruction
of normal tissues. This diagnosis must be supported by
histological evidence of malignancy. The term cancer
includes leukemia, lymphoma and sarcoma.
The following are excluded –
i) All tumors which are histologically described as
carcinoma in situ, benign, pre-malignant, borderline
malignant, low malignant potential, neoplasm of unknown
behavior, or non-invasive, including but not limited to:
Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -
2 and CIN-3.
ii) Any non-melanoma skin carcinoma unless there is
Cancer of evidence of metastases to lymph nodes or beyond;
1 specified iii) Malignant melanoma that has not caused invasion
severity beyond the epidermis;
iv) All tumors of the prostate unless histologically classified
as having a Gleason score greater than 6 or having progressed
to at least clinical TNM classification T2N0M0
v) All Thyroid cancers histologically classified as T1N0M0
(TNM Classification) or below;
vi) Chronic lymphocytic leukaemia less than RAI stage 3
vii) Non-invasive papillary cancer of the bladder
histologically described as TaN0M0 or of a lesser
classification,
viii) All Gastro-Intestinal Stromal Tumors histologically
classified as T1N0M0 (TNM Classification) or below and
with mitotic count of less than or equal to 5/50 HPFs;
ix) All tumors in the presence of HIV infection.
The actual undergoing of heart surgery to correct blockage
or narrowing in one or more coronary artery(s), by
coronary artery bypass grafting done via a sternotomy
(cutting through the breast bone) or minimally invasive
keyhole coronary artery bypass procedures. The diagnosis
Open Chest must be supported by a coronary angiography and the
2 CABG realization of surgery has to be confirmed by a
cardiologist.
The following are excluded:
i. Angioplasty and/or any other intra-arterial
procedures
The first occurrence of heart attack or myocardial infarction,
which means the death of a portion of the heart muscle as a
result of inadequate blood supply to the relevant area. The
diagnosis for Myocardial Infarction should be evidenced by
all of the following criteria:
i. A history of typical clinical symptoms consistent with the
diagnosis of acute myocardial infarction (For e.g. typical
First Heart chest pain)
Attack – of ii. New characteristic electrocardiogram changes
3 specified
iii. Elevation of infarction specific enzymes, Troponins or
severity other specific biochemical markers.
The following are excluded:
i. Other acute Coronary Syndromes
ii. Any type of angina pectoris
iii. A rise in cardiac biomarkers or Troponin T or I in
absence of overt ischemic heart disease OR following an
intra-arterial cardiac procedure.
End stage renal disease presenting as chronic irreversible
Kidney Failure failure of both kidneys to function, as a result of which either
4 requiring regular renal dialysis (hemodialysis or peritoneal dialysis) is
regular dialysis instituted or renal transplantation is carried out. Diagnosis has
to be confirmed by a specialist medical practitioner.
I. The actual undergoing of a transplant of:
i. One of the following human organs: heart, lung, liver,
kidney, pancreas, that resulted from irreversible end-stage
failure of the relevant organ, or
ii. Human bone marrow using haematopoietic stem cells. The
Major Organ/
5 Bone Marrow undergoing of a transplant has to be confirmed by a specialist
medical practitioner.
Transplant
II. The following are excluded:
i. Other stem-cell transplants
Any cerebrovascular incident producing permanent
neurological sequelae. This includes infarction of brain tissue,
thrombosis in an intracranial vessel, haemorrhage and
embolisation from an extracranial source. Diagnosis has to be
confirmed by a specialist medical practitioner and evidenced
Stroke by typical clinical symptoms as well as typical findings in CT
resulting in Scan or MRI of the brain. Evidence of permanent neurological
6 deficit lasting for at least 3 months has to be produced.
permanent
symptoms
The following are excluded:
i. Transient ischemic attacks (TIA)
ii. Traumatic injury of the brain
iii. Vascular disease affecting only the eye or optic nerve or
vestibular functions.
Universal necrosis of the brain cortex with the brainstem
remaining intact. Diagnosis must be confirmed by a
Apallic neurologist acceptable to the Company and the condition must
7
Syndrome be documented for at least one month.
 Benign brain tumor is defined as a life threatening, non-
cancerous tumor in the brain, cranial nerves or meninges
within the skull. The presence of the underlying tumor
must be confirmed by imaging studies such as CT scan
or MRI.
This brain tumor must result in at least one of the following
and must be confirmed by the relevant medical specialist.
Benign Brain i. Permanent Neurological deficit with persisting clinical
8 symptoms for a continuous period of at least 90 consecutive
Tumour
days or
ii. Undergone surgical resection or radiation therapy to treat
the brain tumor.
The following conditions are excluded:
Cysts, Granulomas, malformations in the arteries or veins of
the brain, hematomas, abscesses, pituitary tumors, tumors of
skull bones and tumors of the spinal cord.
A state of unconsciousness with no reaction or response to
external stimuli or internal needs. This diagnosis must be
supported by evidence of all of the following:
i. No response to external stimuli continuously for at least 96
hours;
Coma of ii. Life support measures are necessary to sustain life; and
9 specified iii. Permanent neurological deficit which must be assessed at
severity least 30 days after the onset of the coma.
The condition has to be confirmed by a specialist medical
practitioner. Coma resulting directly from alcohol or drug
abuse is excluded.
Permanent and irreversible failure of liver function that has
resulted in all three of the following:
i. Permanent jaundice; and
End Stage
10 ii. Ascites; and
Liver Disease
iii. Hepatic encephalopathy.
Liver failure secondary to drug or alcohol abuse is excluded.
6 of 37
PSCDEB1-D2C_BlueDart-1822649-1886095
 End stage lung disease, causing chronic respiratory failure, as
confirmed and evidenced by all of the following:
i. FEV1 test results consistently less than 1 litre measured on
3 occasions 3 months apart; and
End Stage ii. Requiring continuous permanent supplementary oxygen
11 therapy for
Lung Disease
hypoxemia; and
iii. Arterial blood gas analysis with partial oxygen pressure of
55mmHg or less (PaO2 < 55mmHg); and
iv. Dyspnea at rest.
The actual undergoing of open-heart valve surgery is to replace
or repair one or more heart valves, as a consequence of defects
in, abnormalities of, or disease-affected cardiac valve(s). The
Open Heart
diagnosis of the valve abnormality must be supported by an
Replacement
12 echocardiography and the realization of surgery has to be
or repair of
confirmed by a specialist medical practitioner. Catheter based
heart valve
techniques including but not limited to, balloon
valvotomy/valvuloplasty are excluded.
Confirmation by a consultant physician acceptable to the
Company of the loss of independent existence due to illness or
trauma, which has lasted for a minimum period of 6 months
and results in a permanent inability to perform at least three (3)
of the Activities of Daily Living (either with or without the use
of mechanical equipment, special devices or other aids and
adaptations in use for disabled persons). For the purpose of this
benefit, the word “permanent”, shall mean beyond the hope of
recovery with current medical knowledge and technology.
Activities of Daily Living are:-
a) Washing: the ability to wash in the bath or shower
(including getting into and out of the bath or shower) or
wash satisfactorily by other means.
b) Dressing: the ability to put on, take off, secure and
Loss of unfasten all garments and, as appropriate, any braces,
13 Independent artificial limbs or other surgical appliances.
Existence c) Transferring: the ability to move from a bed or an upright
chair or wheelchair and vice versa.
d) Mobility: The ability to move indoors from room to room
on level surfaces.
e) Toileting: the ability to use the lavatory or otherwise
manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene.
f) Feeding: the ability to feed oneself once food has been
prepared and made available.
The following is excluded:
Any injury or loss as a result of War, invasion, hostilities
(whether war is declared or not), civil war, rebellion,
revolution or taking part in a riot or civil commotion
The physical separation of two or more limbs, at or above the
wrist or ankle level limbs as a result of injury or disease. This
will include medically necessary amputation necessitated by
injury or disease. The separation has to be permanent without
14 Loss of Limbs any chance of surgical correction. Loss of Limbs resulting
directly or indirectly from self-inflicted injury, alcohol or
drug abuse is excluded.
Total, permanent and irreversible loss of all vision in both eyes
as a result of illness or accident.
The Blindness is evidenced by:
15 Loss of Sight i. corrected visual acuity being 3/60 or less in both eyes or;
ii. the field of vision being less than 10 degrees in both eyes.
The diagnosis of blindness must be confirmed and must not be
correctable by aids or surgical procedure.
There must be third-degree burns with scarring that cover at
least 20% of the body’s surface area. The diagnosis must
16 Major Burns confirm the total area involved using standardized, clinically
accepted, body surface area charts covering 20% of the body
surface area.
Accidental head injury resulting in permanent Neurological
deficit to be assessed no sooner than 3 months from the date of
the accident. This diagnosis must be supported by unequivocal
findings on Magnetic Resonance Imaging, Computerized
Tomography, or other reliable imaging techniques. The
accident must be caused solely and directly by accidental,
violent, external and visible means and independently of all
other causes.
The Accidental Head injury must result in an inability to
perform at least three (3) of the following Activities of Daily
Living either with or without the use of mechanical equipment,
special devices or other aids and adaptations in use for disabled
persons. For the purpose of this benefit, the word “permanent”
shall mean beyond the scope of recovery with current medical
knowledge and technology.
Major Head The Activities of Daily Living are:
17
Trauma i. Washing: the ability to wash in the bath or shower (including
getting into and out of the bath or shower) or wash
satisfactorily by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten
all garments and, as appropriate, any braces, artificial limbs or
other surgical appliances;
iii. Transferring: the ability to move from a bed to an upright
chair or wheelchair and vice versa;
iv. Mobility: the ability to move indoors from room to room
on level surfaces;
v. Toileting: the ability to use the lavatory or otherwise manage
bowel and bladder functions so as to maintain a satisfactory
level of personal hygiene;
vi. Feeding: the ability to feed oneself once food has been
prepared and made available.
The following are excluded:
i. Spinal cord injury;
Total and irreversible loss of use of two or more limbs as a
result of injury or disease of the brain or spinal cord. A
Permanent
specialist medical practitioner must be of the opinion that the
18 Paralysis of
paralysis will be permanent with no hope of recovery and must
Limbs
be present for more than 3 months.
The actual undergoing of surgery (including key-hole type) for
a disease or injury of the aorta needing excision and surgical
Surgery of replacement of the diseased part of the aorta with a graft.
19
Aorta
The term “aorta” means the thoracic and abdominal aorta but
not its branches. Stent-grafting is not covered.
4) Life Assured - means the person as stated in the Rider Schedule on whose life the
contingent events have to occur for the Benefits to be payable. The Life Assured may
be the Policyholder.
5) Main Policy - means or refers to the Policy to which this Rider is annexed/ attached
thereto.
6) A Medical Practitioner - means a person who holds a valid registration from the
medical council of any state of India and is thereby entitled to practice medicine
within its jurisdiction and is acting within the scope and jurisdiction of his license
but excluding the practitioner who is:
a) Insured/Policyholder himself or an agent of the Insured;
b) Insurance Agent, business partner(s) or employer/employee of the
Insured; or
c) A member of the Insured's immediate family.
7) Policyholder, You, you, your - means or refers to the Policyholder stated in the Rider
Schedule.
8) Pre-existing condition - Pre-existing Disease means any condition, ailment, injury
or disease:
• That is/are diagnosed by a physician within 48 months prior to the effective date of
the Rider issued by the insurer or
• For which medical advice or treatment was recommended by, or received from, a
physician within 48 months prior to the effective date of the Rider or its
reinstatement.
• A condition for which any symptoms and or signs if presented and have resulted
within three months of the issuance of the Rider in a diagnostic illness or medical
condition.
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PSCDEB1-D2C_BlueDart-1822649-1886095
9) Rider Sum Assured - means the absolute amount assured to be paid on diagnosis of
any Critical Illnesses of the Life Assured during the Rider Term in accordance with Part D
the terms and conditions of the Rider.
Policy Servicing
10) The terms, conditions and provisions of the Main Policy document shall apply to this
document also. Capitalized terms not defined under this document shall have the
same meaning assigned to them under the Main Policy document. 1. Paid-Up Benefits of Rider
If the Premium under the Rider is discontinued during the Premium Paying Term,
the Rider will lapse without any value. For the avoidance of doubt, no paid-up
Benefits will be payable under this Rider.
Part C
Benefits 2. Revival of the Rider
In case of lapsed Rider, the same can be revived in accordance to the procedure laid
1. Benefits: under the Main Policy. However, this Rider cannot be revived independent of the
Main Policy.
(1) Benefits on Critical Illness
3. Surrender of Rider
For Regular Pay: No benefit is payable on surrender of this Rider.
a) If the Life Assured is diagnosed with any of the specified Critical Illnesses
For Limited Pay: No benefit is payable on surrender during the premium paying term.
listed as per Part B of this Rider, a lump sum benefit equal to the Rider Sum
Post the premium paying term, the following surrender value will be payable:
Assured shall be payable.
50% 𝑥 𝑇𝑜𝑡𝑎𝑙 𝑃𝑟𝑒𝑚𝑖𝑢𝑚𝑠 𝑃𝑎𝑖𝑑 𝑥 𝑈𝑛𝑒𝑥𝑝𝑖𝑟𝑒𝑑 𝐶𝑜𝑣𝑒𝑟𝑎𝑔𝑒 𝑇𝑒𝑟𝑚
b) Subject to other provisions, the Benefit shall be payable if and only if: 𝑂𝑟𝑖𝑔𝑖𝑛𝑎𝑙 𝐶𝑜𝑣𝑒𝑟𝑎𝑔𝑒 𝑇𝑒𝑟𝑚
i. The Rider is in-force as on the date of diagnosis of such Critical
Illness. 4. Alterations
No alterations are permissible under the Rider except change in Frequency of
ii. The Main Policy to which this Rider is attached is in-force as on
Premium Payment if the Premium Payment Frequency under the Main Policy is
the date of diagnosis of such Critical Illness.
being changed. The Premium Payment Frequency of the Rider cannot be changed
iii. Exclusions as per Clause 1 Part F are not attracted.
independently from the Main Policy.
c) The Life Assured must be alive for a period of 30 days from the date of
diagnosis of any of the specified Critical Illnesses. 5. Loans
No loans are permissible under this Rider.
d) A claim shall not be denied on the ground that the Rider was not in force
during the 30 days survival period provided that the diagnosis of the specified 6. Cancellation after the Free-Look Period
Critical Illness(es) was made within the Rider Term. This Rider can be cancelled at any time during the Rider Term without the
cancellation of the Main Policy. Upon such a cancellation, no further Rider
e) Waiting Period - A waiting period of 90 days will be applicable from the Date Premiums are payable. The Rider will be automatically cancelled if the Main
of Risk Commencement of this Rider. If the Life Assured is diagnosed with Policy to which it is attached is cancelled.
any of the specified Critical Illnesses and its onset falls within the waiting
period, then the Policyholder will not be eligible for any Benefits. 7. Termination
Notwithstanding anything contained herein or in the Main Policy, this Rider shall
On revival: automatically terminate on occurrence of the earliest of the following:
 If the Rider is revived within 60 days, only the remaining part of
waiting period will apply. a) Completion of the Rider Term
 If the Rider is revived after 60 days, full 90 day waiting period b) Termination of the Main Policy
will apply afresh. c) Complete withdrawal/surrender of the Main Policy
d) Main Policy not reinstated within 2 years from the date of
f) Pre-existing conditions (defined in Part B) are excluded only for the first 48 discontinuance
months after Rider inception or after reinstatement of Rider, whichever is e) Death of the Life Assured
later. f) On Policyholder’s/Life Assured’s request for cancellation at anytime
during the Rider Term
g) The Rider shall cease once the Benefit has been paid and no further benefits g) Payment of the Benefit under the Rider
will be payable under the Rider. h) Free-look cancellation

h) The Main Policy to which this Rider is attached continues to be in-force after Termination or cancellation of the Rider shall be without prejudice to any claim
a claim for Critical Illness is made under this Rider subject to other terms and arising prior to such termination or cancellation unless otherwise specified.
conditions as applicable on the Main Policy and payment of Premiums due
under the same.

(2) Benefits on Death Part E

No benefit is payable on death under this Rider. Charges

(3) Benefits on Maturity

No charges are applicable under the Rider.
No benefit is payable on maturity under this Rider.

(4) Premium Guarantee

Once the Rider is issued, the Premiums will be guaranteed to the Policyholder for a block
of three years. Subsequently, the Premium may be revised subject to IRDAI's approval.
Any revision in the tabular Premium rates shall be notified to the Policyholder at least three
months prior to the date of such revision. If the Policyholder is not willing to continue the
Rider with the revised Premium rates, the Rider will lapse. Premium rates, if and when
revised, shall be guaranteed to the Policyholder for a subsequent block of three years.
In addition to the above mentioned terms, the terms and conditions mentioned
under Part C of the Main Policy document shall also apply.

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PSCDEB1-D2C_BlueDart-1822649-1886095

Part F
General Terms & Conditions
1. Exclusions
No Benefit will be paid out if the Critical Illness is caused directly or
indirectly as a result of any of the following:
 Any of the specified Critical Illness conditions where death occurs
within 30 days of the diagnosis; or
 Any sickness related condition manifesting itself within 90 days of the
commencement of the Rider/date of acceptance of risk or
reinstatement of cover; or
 Intentionally self-inflicted injury or attempted suicide, irrespective of
mental condition; or
 Alcohol or solvent abuse, or voluntarily taking or using any drug,
medication or sedative unless it is an "over the counter" drug,
medication or sedative taken according to package directions or as
prescribed by a Medical Practitioner; or
 Taking part in any act of a criminal nature with criminal intent; or
 Any Pre-existing condition; or
 HIV or AIDS; or
 Failure to seek or follow medical advice (as recommended by a
Medical Practitioner); or
 Radioactive contamination due to nuclear accident.
2. Claim Procedure
The documents usually required for processing a claim are:
a) Completed claim form (including NEFT details and bank account
proof as specified in the claim form; and
b) Original Main Policy Document and Rider Document; and
c) Medical reports or special reports by registered physician/doctor
relevant to the Critical Illness and its treatment which may be further
validated by a physician/doctor appointed by the Company; and
d) Any other document/ information that the Insurer may decide in the
circumstances of a particular case.
The claim is required to be intimated to us along with all necessary
claim documents within a period of 60 days from the date of
diagnosis. However, we may condone the delay in claim intimation,
if any, where the delay is proved to be for reasons beyond the control
of the claimant as per the provisions of Authority’s Circular No.
IRDA/HLTH/MISC/CIR/216/09/2011, dated 20/09/2011.
3. Assignment and Transfer
Assignment for this Rider shall be as per the provisions of Section 38 of the
Insurance Act, 1938 as amended from time to time. The simplified version
of the provisions of Section 38 is enclosed in Annexure I for your reference.
4. Nomination
Nomination for this Rider shall be as per the Nomination Schedule under the
Main Policy as per Section 39 of the Insurance Act, 1938 as amended from
time to time. The simplified version of the provisions of Section 39 is
enclosed in Annexure II for your reference.
5. Incorrect Information and Non-Disclosure
Fraud, misrepresentation and forfeiture would be dealt with in accordance
with provisions of Section 45 of the Insurance Act 1938 as amended from
time to time. The simplified version of the provisions of Section 45 is
enclosed in Annexure III for your reference.
In addition to the above mentioned terms, the terms and conditions mentioned
under Part F of the Main Policy document shall also apply.
Annexure I
Section 38 - Assignment or Transfer of Insurance Policies
Assignment or transfer of a policy should be in accordance with Section 38 of the
Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015 dated
23.03.2015. The extant provisions in this regard are as follows:
(1) This policy may be transferred/assigned, wholly or in part, with or without
consideration.
(2) An Assignment may be effected in a policy by an endorsement upon the policy
itself or by a separate instrument under notice to the Insurer.
(3) The instrument of assignment should indicate the fact of transfer or assignment
and the reasons for the assignment or transfer, antecedents of the assignee and
terms on which assignment is made.
(4) The assignment must be signed by the transferor or assignor or duly authorized
agent and attested by at least one witness.
(5) The transfer or assignment shall not be operative as against an insurer until a
notice in writing of the transfer or assignment and either the said endorsement or
instrument itself or copy there of certified to be correct by both transferor and
transferee or their duly authorised agents have been delivered to the insurer.
(6) Fee to be paid for assignment or transfer can be specified by the Authority through
Regulations.
(7) On receipt of notice with fee, the insurer should Grant a written acknowledgement
of receipt of notice. Such notice shall be conclusive evidence against the insurer
of duly receiving the notice.
(8) If the insurer maintains one or more places of business, such notices shall be
delivered only at the place where the policy is being serviced.
(9) The insurer may accept or decline to act upon any transfer or assignment or
endorsement, if it has sufficient reasons to believe that it is
a. not bonafide or
b. not in the interest of the policyholder or
c. not in public interest or
d. is for the purpose of trading of the insurance policy.
(10) Before refusing to act upon endorsement, the Insurer should record the reasons in
writing and communicate the same in writing to Policyholder within 30 days from
the date of policyholder giving a notice of transfer or assignment.
(11) In case of refusal to act upon the endorsement by the Insurer, any person aggrieved
by the refusal may prefer a claim to IRDAI within 30 days of receipt of the refusal
letter from the Insurer.
(12) The priority of claims of persons interested in an insurance policy would depend
on the date on which the notices of assignment or transfer is delivered to the
insurer; where there are more than one instruments of transfer or assignment, the
priority will depend on dates of delivery of such notices. Any dispute in this regard
as to priority should be referred to Authority.
(13) Every assignment or transfer shall be deemed to be absolute assignment or transfer
and the assignee or transferee shall be deemed to be absolute assignee or
transferee, except
a. where assignment or transfer is subject to terms and conditions of transfer or
assignment OR
b. where the transfer or assignment is made upon condition that
i. the proceeds under the policy shall become payable to policyholder or
nominee(s) in the event of assignee or transferee dying before the insured OR
ii. the insured surviving the term of the policy
Such conditional assignee will not be entitled to obtain a loan on policy or
surrender the policy. This provision will prevail notwithstanding any law or
custom having force of law which is contrary to the above position.
(14) In other cases, the insurer shall, subject to terms and conditions of assignment,
recognize the transferee or assignee named in the notice as the absolute transferee
or assignee and such person
a. shall be subject to all liabilities and equities to which the transferor or assignor
was subject to at the date of transfer or assignment and
b. may institute any proceedings in relation to the policy
c. obtain loan under the policy or surrender the policy without obtaining the
consent of the transferor or assignor or making him a party to the proceedings.
(15) Any rights and remedies of an assignee or transferee of a life insurance policy
under an assignment or transfer effected before commencement of the Insurance
Laws (Amendment) Act, 2015 shall not be affected by this section.
Disclaimer: This is not a comprehensive list of amendments of Insurance Laws
(Amendment) Act, 2015 and only a simplified version prepared for general
information. Policy Holders are advised to refer to Insurance Laws (Amendment)
Act, 2015 dated 23.03.2015 for complete and accurate details.
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Annexure II
Section 39 - Nomination by policyholder
Nomination of a life insurance Policy is as below in accordance with Section 39 of the
Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015 dated
23.03.2015. The extant provisions in this regard are as follows:
(1) The policyholder of a life insurance on his own life may nominate a person or
persons to whom money secured by the policy shall be paid in the event of his death.
(2) Where the nominee is a minor, the policyholder may appoint any person to receive
the money secured by the policy in the event of policyholder’s death during the
minority of the nominee. The manner of appointment to be laid down by the insurer.
(3) Nomination can be made at any time before the maturity of the policy.
(4) Nomination may be incorporated in the text of the policy itself or may be endorsed
on the policy communicated to the insurer and can be registered by the insurer in
the records relating to the policy.
(5) Nomination can be cancelled or changed at any time before policy matures, by an
endorsement or a further endorsement or a will as the case may be.
(6) A notice in writing of Change or Cancellation of nomination must be delivered to
the insurer for the insurer to be liable to such nominee. Otherwise, insurer will not
be liable if a bonafide payment is made to the person named in the text of the policy
or in the registered records of the insurer.
(7) Fee to be paid to the insurer for registering change or cancellation of a nomination
can be specified by the Authority through Regulations.
(8) On receipt of notice with fee, the insurer should grant a written acknowledgement
to the policyholder of having registered a nomination or cancellation or change
thereof.
(9) A transfer or assignment made in accordance with Section 38 shall automatically
cancel the nomination except in case of assignment to the insurer or other transferee
or assignee for purpose of loan or against security or its reassignment after
repayment. In such case, the nomination will not get cancelled to the extent of
insurer’s or transferee’s or assignee’s interest in the policy. The nomination will get
revived on repayment of the loan.
(10) The right of any creditor to be paid out of the proceeds of any policy of life
insurance shall not be affected by the nomination.
(11) In case of nomination by policyholder whose life is insured, if the nominees die
before the policyholder, the proceeds are payable to policyholder or his heirs or
legal representatives or holder of succession certificate.
(12) In case nominee(s) survive the person whose life is insured, the amount secured by
the policy shall be paid to such survivor(s).
(13) Where the policyholder whose life is insured nominates his
a. parents or
b. spouse or
c. children or
d. spouse and children
e. or any of them
the nominees are beneficially entitled to the amount payable by the insurer to the
policyholder unless it is proved that policyholder could not have conferred such
beneficial title on the nominee having regard to the nature of his title.
(14) If nominee(s) die after the policyholder but before his share of the amount secured
under the policy is paid, the share of the expired nominee(s) shall be payable to the
heirs or legal representative of the nominee or holder of succession certificate of
such nominee(s).
(15) The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to all life
insurance policies maturing for payment after the commencement of Insurance
Laws (Amendment) Act, 2015 (i.e 23.03.2015 ).
(16) If policyholder dies after maturity but the proceeds and benefit of the policy has not
been paid to him because of his death, his nominee(s) shall be entitled to the
proceeds and benefit of the policy.
(17) The provisions of Section 39 are not applicable to any life insurance policy to which
Section 6 of Married Women’s Property Act, 1874 applies or has at any time applied
except where before or after Insurance Laws (Amendment) Act, 2015, a nomination
is made in favour of spouse or children or spouse and children whether or not on
the face of the policy it is mentioned that it is made under Section 39. Where
nomination is intended to be made to spouse or children or spouse and children
under Section 6 of MWP Act, it should be specifically mentioned on the policy. In
such a case only, the provisions of Section 39 will not apply.
Disclaimer: This is not a comprehensive list of amendments of Insurance Laws
(Amendment) Act, 2015 and only a simplified version prepared for general
information. Policy Holders are advised to refer to Insurance Laws (Amendment)
Act, 2015 dated 23.03.2015 for complete and accurate details.
Annexure III
Section 45 – Policy shall not be called in question on the ground of mis-statement
after three years
Provisions regarding policy not being called into question in terms of Section 45 of the
Insurance Act, 1938, as amended by Insurance Laws (Amendment) Act, 2015 dated
23.03.are as follows:
(1) No Policy of Life Insurance shall be called in question on any ground
whatsoever after expiry of 3 yrs from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
(2) On the ground of fraud, a policy of Life Insurance may be called in question
within 3 years from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
For this, the insurer should communicate in writing to the insured or legal
representative or nominee or assignees of insured, as applicable, mentioning
the ground and materials on which such decision is based.
(3) Fraud means any of the following acts committed by insured or by his agent,
with the intent to deceive the insurer or to induce the insurer to issue a life
insurance policy:
a. The suggestion, as a fact of that which is not true and which the insured
does not believe to be true;
b. The active concealment of a fact by the insured having knowledge or belief
of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be fraudulent.
(4) Mere silence is not fraud unless, depending on circumstances of the case, it
is the duty of the insured or his agent keeping silence to speak or silence is in
itself equivalent to speak.
(5) No Insurer shall repudiate a life insurance Policy on the ground of Fraud, if
the Insured / beneficiary can prove that the misstatement was true to the best
of his knowledge and there was no deliberate intention to suppress the fact or
that such mis-statement of or suppression of material fact are within the
knowledge of the insurer. Onus of disproving is upon the policyholder, if
alive, or beneficiaries.
(6) Life insurance Policy can be called in question within 3 years on the ground
that any statement of or suppression of a fact material to expectancy of life
of the insured was incorrectly made in the proposal or other document basis
which policy was issued or revived or rider issued. For this, the insurer should
communicate in writing to the insured or legal representative or nominee or
assignees of insured, as applicable, mentioning the ground and materials on
which decision to repudiate the policy of life insurance is based.
(7) In case repudiation is on ground of mis-statement and not on fraud, the
premium collected on policy till the date of repudiation shall be paid to the
insured or legal representative or nominee or assignees of insured, within a
period of 90 days from the date of repudiation.
(8) Fact shall not be considered material unless it has a direct bearing on the risk
undertaken by the insurer. The onus is on insurer to show that if the insurer
had been aware of the said fact, no life insurance policy would have been
issued to the insured.
(9) The insurer can call for proof of age at any time if he is entitled to do so and
no policy shall be deemed to be called in question merely because the terms
of the policy are adjusted on subsequent proof of age of life insured. So, this
Section will not be applicable for questioning age or adjustment based on
proof of age submitted subsequently.
Disclaimer: This is not a comprehensive list of amendments of Insurance Laws
(Amendment) Act, 2015 and only a simplified version prepared for general
information. Policy Holders are advised to refer to Insurance Laws
(Amendment) Act, 2015 dated 23.03.2015 for complete and accurate details.
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PSCDEB1-D2C_BlueDart-1822649-1886095
 YOUR POLICY AT A GLANCE
This is a document that will help you to understand the key features of this Rider and is not the policy document. In case of any discrepancy between this document and policy document, the policy
document will prevail over this document.

Rider Name & UIN HDFC Life Critical Illness Plus Rider UIN: 101B014V02

Aim of the Rider This is a traditional, non participating Rider that offers lump sum payout on diagnosis of any one of the 19 Critical Illnesses specified

Type of the Rider It is a traditional, non – participating, Critical Illness Rider and can be attached to individual linked and non-linked products.
A lump sum benefit equal to the Rider Sum Assured shall be payable, if the life assured survives for a period of 30 days following the diagnosis of any one of the
Benefit Offered
specified Critical Illnesses. The Rider shall cease once the Rider Sum Assured has been paid out or on the completion of the Rider term, whichever is earlier.

Cancer of specified severity Apallic Syndrome

Open Chest CABG Benign Brain Tumor
First Heart Attack – of specified severity Coma of specified severity
Kidney Failure requiring regular dialysis End Stage Liver Disease
Major Organ/ Bone Marrow Transplant End Stage Lung Disease
Critical Illnesses
Covered Stroke resulting in Permanent symptoms Open Heart Replacement or repair of heart valves
Surgery of Aorta Loss of Limbs
Loss of Independent Existence Major Head Trauma
Loss of Sight Paralysis of limbs
Major Burns
For detailed definitions please refer to the policy document

Maturity Benefit There is no maturity benefit applicable under this Rider

Death Benefit No death benefit is payable under this Rider
Grace Period Grace Period will depend on the Base Plan to which the Rider is attached
Paid Up Benefit There is no Paid Up Benefit available. If Rider premiums are not paid during the premium paying term, the Rider will lapse and no further Benefits will be payable
Lapsation If Rider premiums are not paid during the premium paying term, the Rider will lapse and no further Benefits will be payable
For Regular Pay: No benefit is payable on surrender of this Rider.
For Limited Pay: No benefit is payable on surrender during the premium paying term.
Surrender Benefit Post the premium paying term, the following surrender value will be payable:
50% 𝑥 𝑇𝑜𝑡𝑎𝑙 𝑃𝑟𝑒𝑚𝑖𝑢𝑚𝑠 𝑃𝑎𝑖𝑑 𝑥 𝑈𝑛𝑒𝑥𝑝𝑖𝑟𝑒𝑑 𝐶𝑜𝑣𝑒𝑟𝑎𝑔𝑒 𝑇𝑒𝑟𝑚
𝑂𝑟𝑖𝑔𝑖𝑛𝑎𝑙 𝐶𝑜𝑣𝑒𝑟𝑎𝑔𝑒 𝑇𝑒𝑟𝑚
Revival Revival of the Rider will be as per the revival conditions of the Base Plan to which it is attached.
The policyholder shall have the option of cancelling the Rider, stating the reasons thereof, within 15 days from the date of receipt of the Rider Policy Document, in case
Free Look in period
the policyholder is not agreeable to any Rider terms and conditions. The free-look period for policies purchased through Distance Marketing mode shall be 30 days
Pre-existing Disease means any condition, ailment, injury or disease:
• That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or
Pre Existing • For which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy or its
Conditions reinstatement.
• A condition for which any symptoms and or signs if presented and have resulted within three months of the issuance of the policy in a diagnostic illness or medical
condition.
No Critical Illness Benefit will be paid out if the Critical Illness has occurred directly or indirectly as a result of any of the following:
 Any of the specified Critical Illness conditions, where death occurs within 30 days of the diagnosis
 Any sickness related condition manifesting itself within 90 days of the commencement of the policy/date of acceptance of risk or reinstatement of cover
 Intentionally self-inflicted injury or attempted suicide, irrespective of mental condition
 Alcohol or solvent abuse, or voluntarily taking or using any drug, medication or sedative unless it is an "over the counter" drug, medication or sedative taken
according to package directions or as prescribed by a Medical Practitioner
Exclusions
 Taking part in any act of a criminal nature with criminal intent
 Any Pre-existing medical condition
 HIV or AIDS
 Failure to seek or follow medical advice (as recommended by a Medical Practitioner)
 Radioactive contamination due to nuclear accident
For detailed set of exclusions please refer to the policy document

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 NOMINATION SCHEDULE

Nominee’s Name Mr. MAAN SINGH

Nominee’s Gender M

Nominee’s Relationship with the Life Husband

Assured

Date of Birth of Nominee 4th August 1988

Nominee’s Age 33 Years
Nomination Percentage 100.00%

A-485,STREET NO 16,PART-4
ZERO PUSTA,SONIA VIHAR SABHAPU
Nominee's Address ASHRAM KSHETRA
Delhi - 110094
-
Delhi

Nominee’s Name

Nominee’s Gender

Nominee’s Relationship with the Life

Assured

Date of Birth of Nominee

Nominee’s Age
Nomination Percentage

Nominee's Address
- -

Appointee’s Name
(Applicable where the Nominee is a minor)

Appointee’s Gender
Appointee’s relationship with the Nominee
Date of Birth of Appointee

Appointee's Address
-

Signed at Mumbai on 17th June 2022

For HDFC Life Insurance Company Limited

Authorised Signatory

In case you notice any mistake, you may return the Policy document to us for necessary correction.

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PSCDEB1-D2C_BlueDart-1822649-1886095

Part B
(Definitions)
In this Policy, the following definitions shall be applicable:
1) Annual Premium shall be the premium amount payable in a year
chosen by the Policyholder, excluding the taxes and rider
premiums, but including underwriting extra premiums and
loadings for modal premiums, if any.
2) Annualized Premium shall be the premium amount payable in a
year chosen by the Policyholder, excluding the taxes, rider
premiums, underwriting extra premiums and loadings for modal
premiums, if any.
3) Appointee – means the person named by you/Policyholder and
registered with us in accordance with the Nomination Schedule,
who is authorized to receive the Death Benefit under this Policy
on the death of the Life Assured while the Nominee is a minor;
4) Assignee – means the person to whom the rights and benefits
under this Policy are transferred by virtue of assignment under
section 38 of the Insurance Act, 1938 as amended from time to
time;
5) Assignment – means a provision wherein the Policyholder can
assign or transfer a Policy in accordance with Section 38 of the
Insurance Act, 1938 as amended from time to time;
6) Authority/ IRDAI – means Insurance Regulatory and Development
Authority of India;
7) Company, company, Insurer, Us, us, We, we, Our, our – means or
refers to HDFC Life Insurance Company Limited;
8) BAUP- Board Approved Underwriting Policy of HDFC Life
Insurance Company Limited
9) Date of Risk Commencement - means the date, as stated in the
Policy Schedule, on which the insurance coverage under this
Policy commences;
10) Death Benefit - means the amount which is payable on death of
the Life Assured in accordance with Part C.
11) Distance Marketing - includes every activity of solicitation
(including lead generation) and sale of insurance products through
the following modes: (i) Voice mode, which includes telephone-
calling; (ii) Short Messaging service (SMS)/Whats App; (iii)
Electronic mode which includes e-mail, internet and interactive
television (DTH); (iv) Physical mode which includes direct postal
mail and newspaper & magazine inserts; and, (v) Solicitation
through any means of communication other than in person;
12) Free Look period – means the period specified under Part D
clause 7 from the receipt of the Policy during which Policyholder
can review the terms and conditions of this Policy and where if the
Policyholder is not agreeable to any of the provisions stated in the
Policy, he/ she has the option to return this Policy;
13) Frequency of Premium Payment– means the period, as stated in
the Policy Schedule, between two consecutive Premium due dates
for the Policy;
14) Grace Period – means the time granted by the Insurer from the
due date for the payment of Premium, without any penalty / late
fee, during which the Policy is considered to be in-force with the
risk cover without any interruption as per the terms of this Policy.
15) Life/Lives Assured - means the person(s) as stated in the Policy
Schedule on whose life/lives the contingent events have to occur
for the Benefits to be payable. The Life Assured may be the
Policyholder;
16) Maturity Benefit - means the amount payable on the Maturity Date
in accordance with Part C.
17) Maturity Date - means the date stated in the Policy Schedule, on
which the Policy Term expires and this Policy terminates;
18) Minor – means for purpose of this Policy any person who is below
18 years of age.
19) Nomination - is the process of nominating a person(s) who is (are)
named as “Nominee(s)” in the proposal form or subsequently
included/ changed by an endorsement. Nomination should be in
accordance with provisions of Section 39 of the Insurance Act,
1938 as amended from time to time.
20) Nominee(s) – means the person nominated by the Policyholder
under this Policy and registered with us in accordance with the
Nomination Schedule, to whom money secured by the Policy as
mentioned under the Death Benefit shall be paid in event of the
death of the Life Assured;
21) Policy Anniversary- means the annual anniversary of the Date of
Risk Commencement;
22) Policyholder, You, you, your – means or refers to the Policyholder
stated in the Policy Schedule.
23) Policy Term - means the term of the Policy as stated in the Policy
Schedule;
24) Policy Year- means a period of 12 months starting from the Date
of Risk Commencement.
25) Premium(s)/ Single Premium- means an amount stated in the
Policy Schedule, payable by you to us in the manner stated in the
Policy Schedule, to secure the benefits under this Policy,
excluding applicable taxes and levies;
26) Premium Paying Term – means the period as stated in the Policy
Schedule, in years, over which Premiums are payable;
27) Regulations -means IRDAI (Non Linked Insurance Products)
Regulations, 2019;
28) Revival of a Policy - means restoration of the Policy by the
Company, which was discontinued due to the non-payment of
Premium to the Company, with all the benefits mentioned in the
Policy document, with or without rider benefits, if any, upon the
receipt of all the Premiums due and other charges/late fee, if any,
as per the terms and conditions of the Policy, upon being satisfied
as to the continued insurability of the insured/Policyholder on the
basis of the information, documents and reports furnished by the
Policyholder in accordance with the Board Approved
Underwriting Policy (BAUP) of the Company;
29) Revival Period - means the period of five consecutive years from
the date of first unpaid premium, during which period the
Policyholder is entitled to revive the Policy, which was
discontinued due to the non-payment of Premium, in accordance
with the terms of Revival of a Policy;
30) Sum Assured on Death- means the absolute amount of benefit
which is guaranteed to become payable on death of the life
assured (and in case of Joint Life Coverage, on the death of either
of the Lives Assured) in accordance with the terms and conditions
of the policy;
31) Sum Assured on Maturity -; means the absolute amount of benefit
which is guaranteed to be payable on maturity of the Policy as per
the terms and conditions specified in the Policy;
32) Surrender - means complete withdrawal/ termination of the entire
Policy;
33) Surrender Value - means an amount, if any, that becomes payable
in case of Surrender of the Policy in accordance with the terms
and conditions of the Policy.
34) Total Premiums Paid –Total of all the premiums received,
excluding any extra premium, any rider premium and taxes.
Part C
1. Benefits
(1) Death Benefit
On death of the Life/Lives Assured during the Policy Term and
provided all due Premiums have been paid, the following Death
Benefit shall be payable:
Single Life Coverage:
The Death Benefit payable to the nominee under a Single Life
policy shall be highest of the following:
 Sum Assured on Death
 Death Benefit Multiple (as specified in the Policy
Schedule) times Single Premium (plus any underwriting
extra premium) for a Single Premium policy OR 10 times
Annual Premium for a Regular/Limited Pay policy
 105% of Total Premiums paid till the date of death
 Surrender value applicable as on the date of death.
Upon the payment of the Death Benefit, the policy terminates and
no further benefits are payable.
Joint Life Coverage:
First death: On first death of any of the Lives Assured, the Death
Benefit payable shall be higher of
(a) Sum Assured on Death
(b) 105% of Total Premiums paid till the date of death.
Upon the payment of this benefit on first death, the policy
continues with the surviving life assured
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 Second death: The death benefit payable on the second death
shall be highest of the following:
 Sum Assured on Death
 Death Benefit Multiple (as specified in the Policy
Schedule) times Single Premium (plus any underwriting
extra premium)
 105% of Total Premiums paid till the date of death
 Surrender value applicable as on the date of death.
Simultaneous death of both lives:
 In case of simultaneous death of both the lives, the death
benefit as mentioned above for first and second death shall
be payable.
 The death benefit for the elder life shall be paid in
accordance with the death benefit under ‘First death’ above
and the death benefit for younger life shall be paid in
accordance with the death benefit under ‘Second death’
above.
 Upon the payment of this benefit on the second death, the
policy terminates and no further benefits are payable.
The Death Benefit Multiple for Single Premium has to be chosen
at the outset of the contract and can’t be changed later during the
policy tenure.
Upon the payment of this benefit on the second death, the policy
terminates and no further benefits are payable
(2) Maturity Benefit – On survival of the Life Assured (and in
case of Joint Life Coverage, upon survival of at least one of
the Lives Assured) till the end of the Policy Term and
provided all due Premiums have been paid, the Maturity
Benefit payable shall be a lump sum amount equal to the
Sum Assured on Maturity, where Sum Assured on Maturity
is equal to (Annualized Premium or Single Premium) x
Guaranteed Maturity Multiple (GMM) as specified in the
Policy Schedule.
Once Maturity Benefit is paid, the policy terminates and no
further benefits are payable.
2. Recipients of Benefits
(1) The recipients of Benefits under this Policy shall be as
specified below:
(i) Death Benefit shall be payable to the registered
Nominee(s), if the Policyholder and the Life Assured
are the same; or to the Policyholder if the Life Assured
is other than the Policyholder.
(ii) In case of first death under Joint Life Coverage, Death
Benefit shall be payable to the Policyholder if the
Policyholder and the surviving Life Assured are the
same; or to the Policyholder if the Policyholder is other
than the surviving Life Assured; or to the surviving
Life Assured if the Policyholder and the deceased Life
Assured are the same.
(iii) In case of second death under Joint Life Coverage,
Death Benefit shall be payable to the Policyholder if
the Policyholder is other than the Life Assured(s); or to
the Nominee(s) if the Policyholder and any of the Life
Assured(s) are the same.
(iv) All other Benefits shall be payable to the Policyholder
provided the Policyholder is alive.
(v) Death Benefit shall be paid to legal heir of Policyholder
where Nominee is not alive.
(vi) If the Policy has been assigned, all Benefits shall be
payable to the Assignee under absolute assignment.
3. Payment and cessation of Premiums
(1) The first Premium must be paid along with the submission
of your completed application. Subsequent Premiums are
due in full on the due dates as per the Frequency of
Premium Payment set out in your Policy Schedule.
(2) Premiums under the Policy can be paid on yearly, half-
yearly, quarterly or monthly basis as per the chosen
Frequency of Premium Payment and as set out in the
Policy Schedule or as amended subsequently.
(3) Advance Premium
The Premiums that fall due in the same financial year can
be paid in advance. However, where the Premium due in
one financial year is paid in advance in earlier financial
year, we may collect the same for a maximum period of
three months in advance of the due date of the premium.
(4) If you have chosen monthly premium payment frequency,
we may collect first 3 premiums along with the proposal
form.
(5) Any Premiums paid before the Due Date will be deemed to
have been received on the Due Date for that Regular
Premium.
(6) Grace Period:
Grace period is not applicable for Single Premium. For
Regular/ Limited Premium payment term a grace period of
15 days for monthly Premium paying frequency and 30
days for other Premium paying frequencies is allowed for
the payment of each renewal Premium after the first
Premium. We will not accept part payment of the Premium.
The policy is considered to be in-force with the risk cover
during the grace period without any interruption. Should a
valid claim arise under the Policy during the grace period,
but before the payment of due premium, we shall honor the
claim. In such cases, the due and unpaid premium for the
policy year will be deducted from any benefit payable.
(7) A Premium will be deemed to remain unpaid if the
Premium amount has not been realised by us. If any
Premium remains unpaid after the expiry of the grace
period, your Policy may lapse or become Paid-Up, as
described in Part D Clause 2, with effect from the due date
of the first unpaid Premium. In that event, the Benefits
under such Policy shall be payable in accordance with Part
D Clause 2.
(8) Premiums are payable by you without any obligation on us
to issue a reminder notice to you.
(9) Where the Premiums have been remitted otherwise than in
cash, the application of the Premiums received is
conditional upon the realisation of the proceeds of the
instrument of payment, including electronic mode.
Part D
1. Surrender Value
(1) Guaranteed Surrender Value (“GSV”)
a) The Policy will acquire a GSV immediately on the
payment of Single Premium and on payment of at least first
two years’ premium in case of a Regular/Limited Premium
Policy.
b) Upon payment of the Surrender Benefit the policy shall
terminate and all other benefits shall cease.
c) Subject to a policy having acquired a GSV, the Surrender
Value shall be higher of:
• Guaranteed Surrender Value (GSV) or
• Special Surrender Value (SSV)
Where,
GSV = Applicable GSV factor x Total Premiums paid
The GSV factors applicable for Total Premiums paid are as
specified in Appendix 1.
(2) Special Surrender Value (“SSV”)
The Company shall pay higher of GSV and SSV as
Surrender value.
For Single Premium policies, the SSV value will be
calculated as:
Single Premium * (1+F0)^((month of surrender-1)/12)
For Regular/ Limited Premium policies, the SSV shall be
equal to the Guaranteed
Surrender value until third policy year. From the 4th policy
year onwards, SSV will be computed as the present value
of future benefits as described below:
F1 * Sum Assured on maturity * Premiums paid/ Total
Premiums payable
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PSCDEB1-D2C_BlueDart-1822649-1886095
 Where F0 represents a percentage of maturity return that
will be payable on surrender; F1 is the discounting factor
calculated using prevailing interest rates described in Part
D Clause 4 below, plus k = 225 basis points. Any change in
F0 / F1 factors other than the revision required due to the
change in underlying G-Sec, and any change in formula
and methodology of SSV shall be subject to prior approval
of IRDAI.
2. Lapsed Policies and Paid-Up policies
(1) For Single Premium Policy – Not Applicable
(2) For Regular/Limited Pay Policy - If any due Premium is
unpaid upon the expiry of the grace period and your Policy
has not acquired a GSV, your Policy’s status will be altered
to lapsed status and the cover will cease.
(3) No Benefits are payable under a lapsed Policy.
(4) If any due Premium is unpaid upon the expiry of the grace
period and your Policy has acquired a GSV, your Policy’s
status will be altered to reduced paid-up.
(5) Once the Policy becomes reduced paid-up, following
benefits shall be paid:
On Maturity, “Paid up Sum Assured on Maturity” as
defined below, shall be paid as Maturity benefit.
Paid-up Sum Assured on Maturity = Sum Assured on
Maturity * t / n
(6) On a death claim under a reduced paid up policy, “Paid up
Sum Assured on Death” as defined below, shall be paid as
death benefit.
Paid-up Sum Assured on Death = Max (Sum Assured on Death,
10*Annual Premium) * t/n
In no case, Death benefit payable in case of a paid up policy,
shall be less than the higher of:
 105% of total Premiums paid till the date of death
 Surrender value as on date of death
Where t = Number of premiums paid and n = Number of
premiums payable under the policy
(7) A lapsed or paid-up Policy may be revived subject to the
terms and conditions as described under Part D Clause 3.
(8) If a reduced paid-up policy is subsequently surrendered, the
surrender benefit shall be computed as per Part D Clause 1
above.
3. Revival of the Policy
If your Policy has been paid-up or lapsed, it would be
revived subject to the terms and conditions that we may
specify from time to time. The application for the revival
should be made within five years from the due date of the
first unpaid Premium and before the expiry of the Policy
Term. The revival will be subject to BAUP, satisfactory
evidence of continued insurability of the Life Assured and
payment of outstanding Premiums with interest. The
current rate of interest for revival is 8.50% p.a. Any change
in the revival interest rates will be in accordance with the
following formula: Average Annualised 10-year
benchmark G-Sec Yield (over last 6 months & rounded
upto the nearest 50 bps) + 2%, at the time of the review.
The source of 10-year benchmark G-sec yield shall be RBI
Negotiated Dealing System-Order Matching segment
(NDS-OM).
During revival campaigns, the Company may offer reduced
interest rates, subject to the rules of the special revival
campaign. The reduced interest rates offered during the
revival campaign may vary from year to year. The reduced
interest rate can be maximum upto the prevailing revival
interest rate.
Once the Policy is revived, you are entitled to receive all
contractual Benefits.
4. Discount rate
The discount rate shall be computed with reference to the
prevailing interest rates. The prevailing interest rates will
be derived from average (over last 6 months) yields of G-
Sec securities of 10 years. Any change in the interest rate
used will be in accordance with the formula below:
Annualized Yield on reference government bond + k,
rounded up to the nearest 25 basis points
Where k is defined in the respective sections
The discount rates will be reviewed semi-annually and
shall be revised using the above mentioned formula and the
change in the discount rates shall be effective from 25th
February (average taken from 1st July to 31st December)
and 25th August (average taken from 1st January to 30th
June each year. The revised discount rates shall apply to all
policies including the policies already sold.
5. Alterations
No alterations are permissible under the Policy except
change in Premium Payment Frequency. Alteration in the
Premium Payment Frequency may lead to a change in the
Premium. Such alteration will be in accordance with the
Board approved underwriting policy.
6. Loans
a) Policy loans will be available during the Policy Term
subject to such terms and conditions as the Company may
specify from time to time. Our current terms and conditions
are stated below:
 The loan amount will be subject to a maximum of
80% of the surrender value.
 The current interest rate on loan is 8.50% p.a. The
interest rate on loan shall be calculated as the
Average Annualised 10-year benchmark G-Sec
Yield (over last 6 months & rounded up to the
nearest 50 bps) + 2%. The interest rate shall be
reviewed half-yearly and any change in the interest
rate shall be effective from 25th February and 25th
August each year.
 In case upon review, the interest rate is revised, the
same shall apply until next revision. The source of
10-year benchmark G-sec yield shall be RBI
Negotiated Dealing System-Order Matching segment
(NDS-OM). Any change in the methodology of
calculation of interest rate shall be done with prior
approval of the Authority.
 Before any Benefits are paid out, loan outstanding
together with the interest thereon will be deducted
and the balance amount will be payable
 Once the rate of interest is decided it shall not
change for the entire term of the loan under a
policy.
 For inforce and fully paid up policy, the policy shall
not be foreclosed on the ground of outstanding loan
amount including interest exceeding the surrender
value
 For other than in-force and fully paid up policies, in
case the outstanding loan amount including interest
exceeds the surrender value, the policy shall be
foreclosed after giving intimation and reasonable
opportunity to the policyholder to continue the
policy.
 Any change in the methodology of calculating the
loan interest shall be subject to prior approval of
IRDAI.
7. Free Look Cancellation
In case the Policyholder is not agreeable to any of the
provisions stated in the Policy, the Policyholder has an
option to return the Policy to the Company stating the
reasons thereof, within 15 days from the date of receipt of
the Policy. If the Policy has been purchased through
Distance Marketing mode, this period will be 30 days. On
receipt of the Policyholder’s letter along with the original
Policy document (original Policy Document is not required
for policies in dematerialised form), the Company shall
arrange to refund the Premium paid, subject to deduction of
the proportionate risk Premium for the period on cover and
the expenses incurred by the Company for medical
examination (if any) and stamp duty (if any).
Part E
1. Additional Servicing Charges
No additional servicing charges are applicable in this policy.
15 of 37
PSCDEB1-D2C_BlueDart-1822649-1886095

Part F
1. Exclusions
i. Suicide Exclusion
For Single Life Coverage:
In case of death due to suicide within 12 months from the date of
commencement of risk under the policy or from the date of
revival of the policy, as applicable, the nominee or beneficiary of
the policyholder shall be entitled to at least 80% of the total
premiums paid till the date of death or the surrender value
available as on the date of death whichever is higher, provided the
policy is in force.
For Joint Life Coverage:
In case of death due to suicide within 12 months from the date of
commencement of risk under the policy:
The nominee or beneficiary of the policyholder/life(s) assured
shall be entitled to at least 80% Single Premium or the surrender
value available as on the date of death whichever is higher
provided the policy is in force. The policy shall continue with the
surviving Life Assured, if any, as per the terms and conditions of
the policy.
2. Age Admitted
The Company has calculated the Premiums under the Policy on
the basis of the age of the Life Assured as declared in the
Proposal. In case You have not provided proof of age of the Life
Assured with the Proposal, You will be required to furnish such
proof of age of the Life Assured as is acceptable to us and have
the age admitted. In the event the age so admitted (“Correct
Age”) during the Policy Term is found to be different from the
age declared in the Proposal, without prejudice to our rights and
remedies including those under the Insurance Act, 1938, as
amended from time to time we shall take one of the following
actions (i) if the Correct Age makes the Life Assured ineligible
for this Policy, we will offer him suitable plan as per our
underwriting norms. If you do not wish to opt for the alternative
plan or if it is not possible for us to grant any other plan, the
Policy will stand cancelled from the date of issuance and the
Premiums paid under the Policy will be returned subject to the
deduction of expenses incurred by the Company and the Policy
will terminate thereafter; or (ii) if the Correct Age makes the Life
Assured eligible for the Policy, the difference between the revised
Premium, as per the Correct Age and the original Premium, with
interest, will be due on the next Policy Anniversary date and the
revised Premium will continue for the rest of the Premium
Payment Term. The provisions of Section 45 of the Insurance
Act, 1938 as amended from time to time shall be applicable.
3. Claim Procedure
i. Maturity Benefit: The Maturity Benefit will be paid if:
 The Policy has matured and the Life Assured is alive on
the Maturity Date,
 No claim has been made on the Policy, except any
survival benefit, if any,
 The Policy has not been discontinued or surrendered or
cancelled or terminated, and
 All relevant documents including the original Policy
document in support of your claim have been provided to
the Company.
 Basic documentation for maturity claims:
 Original policy document
 NEFT mandate / discharge voucher
 Bank Account Proof
 KYC documents
ii. Death Benefit: The Death Benefit will be paid if:
 The death of the Life Assured has occurred before the
Maturity Date,
 The Policy has not been discontinued or surrendered or
cancelled or terminated, and
 All relevant documents in support of the claim have been
provided to the Company. These would normally include
the following:
Basic documentation if death is due to Natural Cause:
a. Completed claim form, (including NEFT details and
bank account proof as specified in the claim form);
b. Original Policy;
c. Original or copy Death Certificate issued by Municipal
Authority/ Gram Panchayat / Tehsildar (attested by
issuing authority);
d. Claimant’s identity and residence proof.
Basic documentation if death is due to Un-Natural Cause:
a. Completed claim form, (including NEFT details and
bank account proof as specified in the claim form);
b. Original Policy;
c. Original or copy Death Certificate issued by Municipal
Authority/ Gram Panchayat / Tehsildar (attested by
issuing authority);
d. Claimant’s identity and residence proof.
e. Original or copy of First Information Report, Police
Panchnama report attested by Police authorities; and
f. Original or copy of Postmortem report attested by
Hospital authority, wherever applicable.
Note:
o In case original documents are submitted, attestation on
the document by authorities is not required.
o Depending on the circumstances of the death, further
documents may be called for as we deem fit.
iii. The claim is required to be intimated to us within a period of 90
days from the date of death. However, we may condone the delay
in claim intimation, if any, where the claim is genuine and the
delay is proved to be for reasons beyond the control of the
claimant.
4. Nomination
The Policyholder can nominate a person/ persons in accordance
with Section 39 of the Insurance Act, 1938 as amended from time
to time. Simplified version of the provisions of Section 39 is
enclosed in Annexure I for reference.
5. Assignment
The Policyholder can assign or transfer of a Policy in accordance
with Section 38 of the Insurance Act, 1938 as amended from time
to time. Simplified version of the provisions of Section 38 is
enclosed in Annexure II for reference.
6. Issuance of Duplicate Policy:
The Policyholder can request for a duplicate copy of the Policy at
HDFC Life offices or through Certified Financial Consultant
(Insurance Agent) who advised you while taking this Policy.
While making an application for duplicate Policy the Policyholder
is required to submit a notarized original indemnity bond on stamp
paper. There will be no additional charges for issuance of the
duplicate Policy.
7. Incorrect Information and Non-Disclosure
Fraud and misstatement would be dealt with in accordance with
provisions of Section 45 of the Insurance Act 1938 as amended
from time to time. Simplified version of the provisions of Section
45 is enclosed in Annexure III for reference.
8. Policy on the life of a Minor
Where the Policy has been taken for the benefit of the Life
Assured who is a minor, the Policy shall automatically vest to the
Life Assured on his attaining majority.
9. Taxes
(1)
Indirect Taxes
Taxes and levies shall be levied as applicable. Any taxes and
levies becoming applicable in future may become payable by you
by any method including by levy of an additional monetary
amount in addition to premium and or charges.
(2) Direct Taxes
Tax, if any will be deducted at the applicable rate from the
payments made under the Policy, as per the provisions of the
Income Tax Act, 1961 as amended from time to time.
10. Modification, Amendment, Re-enactment of or to the Insurance
laws and rules, regulations, guidelines, clarifications, circulars
etc. thereunder
i. This Policy is subject to-
 The Insurance Act 1938, as amended from time to time.
 Amendments, modifications (including re-enactment) as may
be made from time to time, and
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  Other such relevant Regulations, Rules, Laws, Guidelines,
Circulars, Enactments etc as may be introduced thereunder
from time to time.
ii. We reserve the right to change any of these Policy Provisions /
terms and conditions in accordance with changes in applicable
Regulations or Laws , and where required, with IRDAI’s approval.
iii. We are required to obtain prior approval from the IRDAI before
making any material changes to these provisions, except for
changes of regulatory / statutory nature.
iv. We reserve the right to require submission by You of such
documents and proof at all life stages of the Policy as may be
necessary to meet the requirements under Anti- money
Laundering/Know Your Customer norms and as may be laid down
by IRDAI and other regulators from time to time.

11. Jurisdiction:
This Policy shall be governed by the laws of India and the Indian Courts
shall have jurisdiction to settle any disputes arising under the Policy.

12. Notices
Any notice, direction or instruction given to Us, under the Policy, shall be
in writing and delivered by hand, post, facsimile or from registered
electronic mail ID to:
HDFC Life Insurance Company Limited, 11th Floor, Lodha Excelus,
Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai -
400011.
Registered Office: Lodha Excelus, 13th Floor, Apollo Mills Compound,
N.M. Joshi Marg, Mahalaxmi, Mumbai - 400011.
Helpline number: 18602679999 (Local charges apply)
E-mail: service@hdfclife.com
Or such other address as may be informed by Us.
Similarly, any notice, direction or instruction to be given by Us, under the
Policy, shall be in writing and delivered by hand, post, courier, facsimile
or registered electronic mail ID to the updated address in the records of
the Company.
You are requested to communicate any change in address, to the
Company supported by the required address proofs to enable the
Company to carry out the change of address in its systems. The onus of
intimation of change of address lies with the Policyholder. An updated
contact detail of the Policyholder will ensure that correspondences from
the Company are correctly addressed to the Policyholder at the latest
updated address.

Appendix 1: Guaranteed Surrender Value Factors

Guaranteed Surrender Value Factors as percentage of Total Premiums Paid

Note: This would only be payable once the policy has acquired a guaranteed surrender value.

For Single Premium: 100%

For Regular/ Limited Pay:

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Policy Year/ Policy Term 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

2 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%

3 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35%

4 90% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

5 90% 90% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

6 90% 90% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

7 90% 90% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

8 90% 90% 70% 63% 60% 58% 57% 56% 55% 54% 54% 54% 53%

9 90% 90% 77% 70% 66% 63% 61% 60% 59% 58% 57% 57%

10 90% 90% 80% 74% 70% 67% 65% 63% 62% 61% 60%

11 90% 90% 82% 77% 73% 70% 68% 66% 65% 63%

12 90% 90% 83% 79% 75% 72% 70% 68% 67%

13 90% 90% 84% 80% 77% 74% 72% 70%

14 90% 90% 85% 81% 78% 75% 73%

15 90% 90% 86% 82% 79% 77%

16 90% 90% 86% 83% 80%

17 90% 90% 86% 83%

18 90% 90% 87%

19 90% 90%

20 90%

Policy
Year/
21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
Policy
Term

1 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

2 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30% 30%

3 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35%

4 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

5 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

6 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

7 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

8 53% 53% 53% 53% 52% 52% 52% 52% 52% 52% 52% 52% 52% 52% 51% 51% 51% 51% 51% 51%

9 56% 56% 55% 55% 55% 54% 54% 54% 54% 54% 53% 53% 53% 53% 53% 53% 53% 53% 53% 53%

10 59% 59% 58% 58% 57% 57% 56% 56% 56% 55% 55% 55% 55% 55% 54% 54% 54% 54% 54% 54%

11 62% 61% 61% 60% 59% 59% 58% 58% 58% 57% 57% 57% 56% 56% 56% 56% 56% 55% 55% 55%

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12 65% 64% 63% 63% 62% 61% 61% 60% 60% 59% 59% 58% 58% 58% 57% 57% 57% 57% 56% 56%

13 68% 67% 66% 65% 64% 63% 63% 62% 61% 61% 60% 60% 60% 59% 59% 59% 58% 58% 58% 58%

14 72% 70% 69% 68% 66% 66% 65% 64% 63% 63% 62% 62% 61% 61% 60% 60% 60% 59% 59% 59%

15 75% 73% 71% 70% 69% 68% 67% 66% 65% 65% 64% 63% 63% 62% 62% 61% 61% 61% 60% 60%

16 78% 76% 74% 73% 71% 70% 69% 68% 67% 66% 66% 65% 64% 64% 63% 63% 62% 62% 62% 61%

17 81% 79% 77% 75% 74% 72% 71% 70% 69% 68% 67% 67% 66% 65% 65% 64% 64% 63% 63% 63%

18 84% 81% 79% 78% 76% 74% 73% 72% 71% 70% 69% 68% 68% 67% 66% 66% 65% 65% 64% 64%

19 87% 84% 82% 80% 78% 77% 75% 74% 73% 72% 71% 70% 69% 68% 68% 67% 67% 66% 65% 65%

20 90% 87% 85% 83% 81% 79% 77% 76% 75% 74% 73% 72% 71% 70% 69% 69% 68% 67% 67% 66%

21 90% 90% 87% 85% 83% 81% 79% 78% 77% 75% 74% 73% 72% 72% 71% 70% 69% 69% 68% 67%

22 90% 90% 88% 85% 83% 82% 80% 79% 77% 76% 75% 74% 73% 72% 71% 71% 70% 69% 69%

23 90% 90% 88% 86% 84% 82% 80% 79% 78% 77% 76% 75% 74% 73% 72% 71% 71% 70%

24 90% 90% 88% 86% 84% 82% 81% 80% 78% 77% 76% 75% 74% 73% 73% 72% 71%

25 90% 90% 88% 86% 84% 83% 81% 80% 79% 78% 77% 76% 75% 74% 73% 72%

26 90% 90% 88% 86% 85% 83% 82% 80% 79% 78% 77% 76% 75% 75% 74%

27 90% 90% 88% 86% 85% 83% 82% 81% 80% 79% 78% 77% 76% 75%

28 90% 90% 88% 87% 85% 84% 82% 81% 80% 79% 78% 77% 76%

29 90% 90% 88% 87% 85% 84% 83% 81% 80% 79% 78% 77%

30 90% 90% 88% 87% 85% 84% 83% 82% 81% 80% 79%

31 90% 90% 88% 87% 86% 84% 83% 82% 81% 80%

32 90% 90% 88% 87% 86% 84% 83% 82% 81%

33 90% 90% 89% 87% 86% 85% 84% 82%

34 90% 90% 89% 87% 86% 85% 84%

35 90% 90% 89% 87% 86% 85%

36 90% 90% 89% 87% 86%

37 90% 90% 89% 87%

38 90% 90% 89%

39 90% 90%

40 90%

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PSCDEB1-D2C_BlueDart-1822649-1886095
 Annexure I
Section 39 - Nomination by policyholder
Nomination of a life insurance Policy is as below in accordance with Section
39 of the Insurance Act, 1938 as amended by Insurance Laws (Amendment)
Act, 2015 dated 23.03.2015. The extant provisions in this regard are as
follows:
1) The policyholder of a life insurance on his own life may nominate a
person or persons to whom money secured by the policy shall be paid in
the event of his death.
2) Where the nominee is a minor, the policyholder may appoint any person
to receive the money secured by the policy in the event of
policyholder’s death during the minority of the nominee. The manner of
appointment to be laid down by the insurer.
3) Nomination can be made at any time before the maturity of the policy.
4) Nomination may be incorporated in the text of the policy itself or may
be endorsed on the policy communicated to the insurer and can be
registered by the insurer in the records relating to the policy.
5) Nomination can be cancelled or changed at any time before policy
matures, by an endorsement or a further endorsement or a will as the
case may be.
6) A notice in writing of Change or Cancellation of nomination must be
delivered to the insurer for the insurer to be liable to such nominee.
Otherwise, insurer will not be liable if a bonafide payment is made to
the person named in the text of the policy or in the registered records of
the insurer.
7) Fee to be paid to the insurer for registering change or cancellation of a
nomination can be specified by the Authority through Regulations.
8) On receipt of notice with fee, the insurer should grant a written
acknowledgement to the policyholder of having registered a nomination
or cancellation or change thereof.
9) A transfer or assignment made in accordance with Section 38 shall
automatically cancel the nomination except in case of assignment to the
insurer or other transferee or assignee for purpose of loan or against
security or its reassignment after repayment. In such case, the
nomination will not get cancelled to the extent of insurer’s or
transferee’s or assignee’s interest in the policy. The nomination will get
revived on repayment of the loan.
10) The right of any creditor to be paid out of the proceeds of any policy of
life insurance shall not be affected by the nomination.
11) In case of nomination by policyholder whose life is insured, if the
nominees die before the policyholder, the proceeds are payable to
policyholder or his heirs or legal representatives or holder of succession
certificate.
12) In case nominee(s) survive the person whose life is insured, the amount
secured by the policy shall be paid to such survivor(s).
13) Where the policyholder whose life is insured nominates his (a) parents
or (b) spouse or (c) children or (d) spouse and children (e) or any of
them; the nominees are beneficially entitled to the amount payable by
the insurer to the policyholder unless it is proved that policyholder could
not have conferred such beneficial title on the nominee having regard to
the nature of his title.
14) If nominee(s) die after the policyholder but before his share of the
amount secured under the policy is paid, the share of the expired
nominee(s) shall be payable to the heirs or legal representative of the
nominee or holder of succession certificate of such nominee(s).
15) The provisions of sub-section 7 and 8 (13 and 14 above) shall apply to
all life insurance policies maturing for payment after the
commencement of Insurance Laws (Amendment) Act, 2015 (i.e.
23.03.2015).
16) If policyholder dies after maturity but the proceeds and benefit of the
policy has not been paid to him because of his death, his nominee(s)
shall be entitled to the proceeds and benefit of the policy.
17) The provisions of Section 39 are not applicable to any life insurance
policy to which Section 6 of Married Women’s Property Act, 1874
applies or has at any time applied except where before or Insurance
Laws (Amendment) Act, 2015, a nomination is made in favour of
spouse or children or spouse and children whether or not on the face of
the policy it is mentioned that it is made under Section 39. Where
nomination is intended to be made to spouse or children or spouse and
children under Section 6 of MWP Act, it should be specifically
mentioned on the policy. In such a case only, the provisions of Section
39 will not apply.
[Disclaimer: This is not a comprehensive list of amendments of Insurance
Laws (Amendment) Act, 2015and only a simplified version prepared for
general information. Policy Holders are advised to refer to Insurance Laws
(Amendment) Act, 2015dated 23.03.2015 for complete and accurate details.
Annexure II
Section 38 - Assignment or Transfer of Insurance Policies
Assignment or transfer of a policy should be in accordance with Section 38 of
the Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act,
2015 dated 23.03.2015. The extant provisions in this regard are as follows:
(1) This policy may be transferred/assigned, wholly or in part, with or
without consideration.
(2) An Assignment may be effected in a policy by an endorsement upon
the policy itself or by a separate instrument under notice to the
Insurer.
(3) The instrument of assignment should indicate the fact of transfer or
assignment and the reasons for the assignment or transfer,
antecedents of the assignee and terms on which assignment is made.
(4) The assignment must be signed by the transferor or assignor or duly
authorized agent and attested by at least one witness.
(5) The transfer or assignment shall not be operative as against an
insurer until a notice in writing of the transfer or assignment and
either the said endorsement or instrument itself or copy there of
certified to be correct by both transferor and transferee or their duly
authorised agents have been delivered to the insurer.
(6) Fee to be paid for assignment or transfer can be specified by the
Authority through Regulations.
(7) On receipt of notice with fee, the insurer should Grant a written
acknowledgement of receipt of notice. Such notice shall be
conclusive evidence against the insurer of duly receiving the notice.
(8) If the insurer maintains one or more places of business, such notices
shall be delivered only at the place where the policy is being
serviced.
(9) The insurer may accept or decline to act upon any transfer or
assignment or endorsement, if it has sufficient reasons to believe that
it is (a) not bonafide or (b) not in the interest of the policyholder or
(c) not in public interest or (d) is for the purpose of trading of the
insurance policy.
(10) Before refusing to act upon endorsement, the Insurer should record
the reasons in writing and communicate the same in writing to
Policyholder within 30 days from the date of policyholder giving a
notice of transfer or assignment.
(11) In case of refusal to act upon the endorsement by the Insurer, any
person aggrieved by the refusal may prefer a claim to IRDAI within
30 days of receipt of the refusal letter from the Insurer.
(12) The priority of claims of persons interested in an insurance policy
would depend on the date on which the notices of assignment or
transfer is delivered to the insurer; where there are more than one
instruments of transfer or assignment, the priority will depend on
dates of delivery of such notices. Any dispute in this regard as to
priority should be referred to Authority.
(13) Every assignment or transfer shall be deemed to be absolute
assignment or transfer and the assignee or transferee shall be deemed
to be absolute assignee or transferee, except
a. where assignment or transfer is subject to terms and conditions of
transfer or assignment OR
b. where the transfer or assignment is made upon condition that
i. the proceeds under the policy shall become payable to
policyholder or nominee(s) in the event of assignee or transferee
dying before the insured OR
ii. the insured surviving the term of the policy
Such conditional assignee will not be entitled to obtain a loan on
policy or surrender the policy. This provision will prevail
notwithstanding any law or custom having force of law which is
contrary to the above position.
(14) In other cases, the insurer shall, subject to terms and conditions of
assignment, recognize the transferee or assignee named in the notice
as the absolute transferee or assignee and such person
a. shall be subject to all liabilities and equities to which the
transferor or assignor was subject to at the date of transfer or
assignment and
b. may institute any proceedings in relation to the policy
c. obtain loan under the policy or surrender the policy without
obtaining the consent of the transferor or assignor or making
him a party to the proceedings
20 of 37
PSCDEB1-D2C_BlueDart-1822649-1886095
(15) Any rights and remedies of an assignee or transferee of a life
insurance policy under an assignment or transfer effected before
commencement of the Insurance Laws (Amendment) Act, 2015
shall not be affected by this section.
[Disclaimer: This is not a comprehensive list of amendments of Insurance
Laws (Amendment) Act, 2015 and only a simplified version prepared for
general information. Policy Holders are advised to refer to InsuranceLaws
(Amendment) Act, 2015dated 23.03.2015 for complete and accurate details. ]
Annexure III
Section 45 – Policy shall not be called in question on the ground of mis-
statement after three years
insurer had been aware of the said fact, no life insurance policy would
have been issued to the insured.
9) The insurer can call for proof of age at any time if he is entitled to do so
and no policy shall be deemed to be called in question merely because
the terms of the policy are adjusted on subsequent proof of age of life
insured. So, this Section will not be applicable for questioning age or
adjustment based on proof of age submitted subsequently.
[Disclaimer: This is not a comprehensive list of amendments of Insurance
Laws (Amendment) Act, 2015and only a simplified version prepared for
general information. Policy Holders are advised to refer to Insurance Laws
(Amendment) Act, 2015 dated 23.03.2015 for complete and accurate details.
]

Provisions regarding policy not being called into question in terms of Section
45 of the Insurance Act, 1938, as amended Insurance Laws (Amendment) Act,
2015 dated 23.03.2015are as follows:

1) No Policy of Life Insurance shall be called in question on any ground

whatsoever after expiry of 3 yrs from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
2) On the ground of fraud, a policy of Life Insurance may be called in
question within 3 years from
a. the date of issuance of policy or
b. the date of commencement of risk or
c. the date of revival of policy or
d. the date of rider to the policy
whichever is later.
For this, the insurer should communicate in writing to the insured or
legal representative or nominee or assignees of insured, as applicable,
mentioning the ground and materials on which such decision is based.
3) Fraud means any of the following acts committed by insured or by his
agent, with the intent to deceive the insurer or to induce the insurer to
issue a life insurance policy:
a. The suggestion, as a fact of that which is not true and which the
insured does not believe to be true;
b. The active concealment of a fact by the insured having knowledge or
belief of the fact;
c. Any other act fitted to deceive; and
d. Any such act or omission as the law specifically declares to be
fraudulent.
4) Mere silence is not fraud unless, depending on circumstances of the
case, it is the duty of the insured or his agent keeping silence to speak or
silence is in itself equivalent to speak.
5) No Insurer shall repudiate a life insurance Policy on the ground of
Fraud, if the Insured / beneficiary can prove that the misstatement was
true to the best of his knowledge and there was no deliberate intention to
suppress the fact or that such mis-statement of or suppression of
material fact are within the knowledge of the insurer. Onus of
disproving is upon the policyholder, if alive, or beneficiaries.
6) Life insurance Policy can be called in question within 3 years on the
ground that any statement of or suppression of a fact material to
expectancy of life of the insured was incorrectly made in the proposal or
other document basis which policy was issued or revived or rider issued.
For this, the insurer should communicate in writing to the insured or
legal representative or nominee or assignees of insured, as applicable,
mentioning the ground and materials on which decision to repudiate the
policy of life insurance is based.
7) In case repudiation is on ground of mis-statement and not on fraud, the
premium collected on policy till the date of repudiation shall be paid to
the insured or legal representative or nominee or assignees of insured,
within a period of 90 days from the date of repudiation.
8) Fact shall not be considered material unless it has a direct bearing on the
risk undertaken by the insurer. The onus is on insurer to show that if the

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PSCDEB1-D2C_BlueDart-1822649-1886095
SPACE FOR ENDORSEMENTS

22 of 37

PSCDEB1-D2C_BlueDart-1822649-1886095
 Office Copy
FIRST PREMIUM RECEIPT
Date: 15/06/2022
We certify that the premium amount mentioned below, which was received from you as
initial deposit has, consequent to the issue of a Life Insurance policy, been accounted by
us towards First Premium payable.

Policy No. 25008178 Client Id : NV552147

Plan HDFC Life Sanchay Fixed Maturity Plan

Policy Holder Ms. POOJA RANA

Premium Amount
(Including Taxes and ` 31,482.00
Levies as applicable)
Premium Adjusted
27th May 2022
with effect from :

(B) - The premiums paid are allowed as deduction from the Gross Total Income under Section
80 C of the Income Tax Act,1961, subject to limits specified there in.

Yours sincerely,
For HDFC Life Insurance Company Limited.

Authorised Signatory

HDFC LIFE INSURANCE COMPANY LIMITED

Branch Address:HDFC Life Delhi-Rohini-Sec-3 B, 3rd floor 301 Plot 15 N N Mall, Mangalam Place District Center, Rohini
Sector 3, Delhi, 110085
Corporate Office: 12th & 13th Floor, Lodha Excelus, Apollo Mills Compound, N. M. Joshi Marg, Mahalaxmi, Mumbai - 400
011.
Registered Office: Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400 011.

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PSCDEB1-D2C_BlueDart-1822649-1886095
 YOUR POLICY AT A GLANCE
This is a document that will help you to understand the key features of this product and is not the policy document. In case of any discrepancy between this document and your
policy document, the policy document will prevail over this document.

Plan Name &

HDFC Life Sanchay Fixed Maturity Plan UIN: 101N142V01
UIN
This is A Non-Participating, Non-Linked Savings insurance plan for single/joint life with lumpsum benefit payable on Maturity. This plan
Aim of the plan
provides guaranteed benefits along with flexibility to choose your investment term.
Type of the Plan A Non-Participating, Non-Linked Savings insurance plan
Premium
Payment Term Premium Payment Term Policy Term
(years) and Non POS Variant POS Variant
Policy Term Single Pay 5 to 40 years 5 to 20 years
(years) 5/6/7/8/10/12/15/20 PPT to 40 years PPT to 20 years
Following riders are offered under this product
Name of the Rider UIN
HDFC Life Income Benefit on Accidental Disability Rider 101B013V03
Riders HDFC Life Critical Illness Plus Rider 101B014V02
HDFC Life Protect Plus Rider 101B016V01

No riders will be available for POS Variant.

Maturity Benefit is payable as a lump sum at the end of the policy term. The guaranteed Maturity Benefit payable is Sum Assured on Maturity
which is defined as Annualized Premium or Single Premium times Guaranteed Maturity Multiple (GMM).
Maturity Benefit
The GMM varies by age and premium payment term.
On payment of the Maturity Benefit, the policy will terminate and no more benefits will be payable.

Single Life Coverage:

The death benefit payable under a Single Life policy shall be highest of the following:
• Sum Assured on Death
• Death Benefit Multiple (as chosen by the policyholder) times Single Premium (plus any underwriting extra premium) for a Single Pay policy or
10 times Annual Premium for a Regular/ Limited pay policy
• 105% of total Premiums paid till the date of death
• Surrender value applicable as on the date of death.

Upon the payment of the death benefit, the policy terminates and no further benefits are payable.

Joint Life Coverage:

First death: The death benefit payable on first death shall be higher of the following:
• Sum Assured on Death
• 105% of Total Premiums paid till the date of death
Death Benefit
Upon the payment of this benefit on first death, the policy continues with the surviving life.

Second death: The death benefit payable on the second death shall be highest of the following:
• Sum Assured on Death
• Death Benefit Multiple (as chosen by the policyholder) times Single Premium (plus any underwriting extra premium)
• 105% of Total Premiums paid till the date of death
• Surrender value applicable as on the date of death

Simultaneous death of both lives:

In case of simultaneous death of both the lives, the death benefit as mentioned above for first and second death shall be payable. The death
benefit for the elder life shall be paid in accordance with the death benefit under ‘First death’ above and the death benefit for younger life shall be
paid in accordance with the death benefit under ‘Second death’ above.

Upon the payment of this benefit on the second death, the policy terminates and no further benefits are payable.
•Death Benefit shall be payable to the registered Nominee(s), if the Policyholder and the Life Assured are the same; or to the Policyholder if the
Life Assured is other than the Policyholder.
•In case of first death under Joint Life Coverage, Death Benefit shall be payable to the Policyholder if the Policyholder and the surviving Life
Assured are the same; or to the Policyholder if the Policyholder is other than the surviving Life Assured; or to the surviving Life Assured if the
Recipient of Policyholder and the deceased Life Assured are the same.
Benefits •In case of second death under Joint Life Coverage, Death Benefit shall be payable to the Policyholder if the Policyholder is other than the Life
Assured(s); or to the Nominee(s) if the Policyholder and any of the Life Assured(s) are the same.
•All other Benefits shall be payable to the Policyholder provided the Policyholder is alive.
•Death Benefit shall be paid to legal heir of Policyholder where Nominee is not alive.
• If the Policy has been assigned, all Benefits shall be payable to the Assignee under absolute assignment.
Once the policy has acquired a Surrender Value, you can take a policy loan upto 80% of the surrender value of your policy, subject to the
Policy Loans
applicable terms and conditions
For Single Life Coverage:
In case of death due to suicide within 12 months from the date of commencement of risk under the policy or from the date of revival of the
Exclusion policy, as applicable, the nominee or beneficiary of the policyholder shall be entitled to at least 80% of the total premiums paid till the date of
death or the surrender value available as on the date of death whichever is higher, provided the policy is in force.

24 of 37

PSCDEB1-D2C_BlueDart-1822649-1886095
 For Joint Life Coverage:
If death due to suicide occurs within 12 months from the date of commencement of risk under the policy
• The nominee or beneficiary of the policyholder/life(s) assured shall be entitled to at least 80% of Single Premium or the surrender value
available as on the date of death whichever is higher provided the policy is in force.

The policy shall continue with the surviving Life Assured, if any, as per the terms and conditions of the policy.
Free Look in 15 days from the date of receipt of the original policy document.
period If you have purchased your Policy through Distance Marketing this period will be 30 days.
Not Applicable for Single Pay policy,
Grace Period
For Regular/ Limited Pay policy: 15 days from the premium due date for monthly mode and 30 days from the premium due date for other modes.
Not Applicable for Single Pay policy.

For a Regular/ Limited Pay policy - If a due premium is unpaid upon the expiry of the grace period, the policy shall:
• Lapse if it has not acquired a Guaranteed Surrender Value
Paid-up/ Lapse
• Become reduced paid-up if it has acquired a Guaranteed Surrender Value
All the benefits shall cease once a policy lapses

Once the policy becomes reduced paid-up, the maturity and death benefit payouts shall be payable as specified in the policy document.
Revival A lapsed or paid up policy can be revived within 5 years subject to the conditions mentioned in the policy document.
A policy shall acquire a Guaranteed Surrender Value (GSV) immediately on the payment of Single Premium and on payment of at least two
years’ premium in case of a Regular/Limited premium paying policy.

Subject to a policy having acquired a GSV, the surrender value shall be equal to the higher of:
Surrender • Guaranteed Surrender Value (GSV) or
• Special Surrender Value (SSV),
Upon payment of the surrender benefit the policy shall terminate and all other benefits shall cease.

The Company shall pay higher of GSV and SSV as Surrender value.

25 of 37

PSCDEB1-D2C_BlueDart-1822649-1886095
 Part G
1. Grievance Redressal Process a. Details and addresses of Insurance Ombudsman
(i) The customer can contact us on the below mentioned address or at
any of our branches in case of any complaint/ grievance: Office of the
Grievance Redressal Officer Contact Details Areas of Jurisdiction
Ombudsman
HDFC Life Insurance Company Limited AHMEDABAD -
11th Floor, Lodha Excelus, Apollo Mills Compound, Shri Kuldip Singh
N. M. Joshi Marg, Mahalaxmi, Mumbai, Maharashtra - 400011 Office of the
Helpline number: 18602679999 (Local charges apply) Insurance
E-mail: service@hdfclife.com Ombudsman,
(ii) All grievances (Service and sales) received by the Company will be Jeevan Prakash
responded to within the prescribed regulatory Turn Around Time Building, 6th
(TAT) of 15 days. floor,
(iii) Written request or email from the registered email id is mandatory. Gujarat,
Tilak Marg, Relief
(iv) If required, we will investigate the complaints by taking inputs AHMEDABAD Dadra & Nagar Haveli,
Road,
from the customer over the telephone or through personal meetings. Daman and Diu.
Ahmedabad – 380
(v) We will issue an acknowledgement letter to the customer within 3 001.
working days of the receipt of complaint. Tel.: 079 -
(vi) The acknowledgement that is sent to the customer has the details of 25501201/02/05/0
the complaint number, the Policy number and the Grievance 6
Redressal Officer’s name who will be handling the complaint of the Email: bimalokpal
customer. .ahmedabad@cioi
(vii) If the customer’s complaint is addressed within 3 days, the ns.co.in
resolution communication will also act as the acknowledgment of BHOPAL - Shri R
the complaint. M Singh
(viii) The final letter of resolution will offer redressal or rejection of the Office of the
complaint along with the appropriate reason for the same. Insurance
(ix) In case the customer is not satisfied with the decision sent to him or Ombudsman,
her, he or she may contact our Grievance Redressal Officer within Janak Vihar
8 weeks of the receipt of the communication at any of the touch Complex, 2nd
points mentioned in the document, failing which, we will consider Floor,
the complaint to be satisfactorily resolved. 6, Malviya Nagar,
(x) The following is the escalation matrix in case there is no response Opp. Airtel
within the prescribed timelines or if you are not satisfied with the Madhya Pradesh
BHOPAL Office,
response. The number of days specified in the below- mentioned Chattisgarh.
Near New Market,
escalation matrix will be applicable from the date of escalation. Bhopal – 462 003.
Designati Respon Tel.: 0755 -
Level Email ID Address
on se Time 2769201 /
Sr. 2769202
Manager Fax: 0755 -
OR 2769203
Associate 10 11th Floor, Email: bimalokpal
1st escalation1@hdfcli
Vice workin Lodha .bhopal@cioins.c
Level fe.in
President g days Excelus, o.in
– Apollo
Customer Mills Office of the
Relations Compound, Insurance
2nd N M Joshi Ombudsman,
Vice
Level Marg , 62, Forest park,
President
(for Mahalaksh Bhubneshwar –
OR Sr.
respon 7 mi, 751 009.
Vice escalation2@hdfcli BHUBANESH
se not workin Mumbai Tel.: 0674 - Orissa.
President fe.in WAR
receive g days 400011 2596461
–
d from /2596455
Customer
Level Fax: 0674 -
Relations
1) 2596429
Email: bimalokpal
You are requested to follow the aforementioned matrix to receive .bhubaneswar@ci
satisfactory response from us. oins.co.in
Office of the
(xi) If you are not satisfied with the response or do not receive a response from Insurance
us within 15 days, you may approach the Grievance Cell of IRDAI on Ombudsman,
the following contact details: Jeevan Soudha
 IRDAI Grievance Call Centre (IGCC) TOLL FREE NO: Building,PID No.
155255/ 18004254732 57-27-N-19
 Email ID: complaints@irdai.gov.in Ground Floor,
 Online- You can register your complaint online at 19/19, 24th Main
http://www.igms.irdai.gov.in/ Road,
 Address for communication for complaints by fax/paper: BENGALURU JP Nagar, Ist Karnataka.
General Manager Phase,
Consumer Affairs Department – Grievance Redressal Cell Bengaluru – 560
Insurance Regulatory and Development Authority of India 078.
Sy No. 115/1, Financial District, Tel.: 080 -
Nanakramguda, Gachibowli, 26652048 /
Hyderabad – 500 032 26652049
Email: bimalokpal
2. In the event you are dissatisfied with the response provided by us, you may .bengaluru@cioin
approach the Insurance Ombudsman in your region. The details of the existing s.co.in
offices of the Insurance Ombudsman are provided below. You are requested
to refer to the IRDAI website at “www.irdai.gov.in” for the updated details.

26 of 37
 Office of the Fax: 040 -
Insurance 23376599
Ombudsman, Email: bimalokpal
S.C.O. No. 101, .hyderabad@cioin
102 & 103, 2nd s.co.in
Punjab,
Floor, Office of the
Haryana(excluding
Batra Building, Insurance
Gurugram, Faridabad,
Sector 17 – D, Ombudsman,
Sonepat and
CHANDIGARH Chandigarh – 160 Jeevan Nidhi – II
Bahadurgarh)
017. Bldg., Gr. Floor,
Himachal Pradesh,
Tel.: 0172 - Bhawani Singh
Union Territories of
2706196 / Marg,
Jammu & Kashmir, JAIPUR Rajasthan.
2706468 Jaipur - 302 005.
Ladakh & Chandigarh.
Fax: 0172 - Tel.: 0141 -
2708274 2740363
Email: bimalokpal Email: bimalokpal
.chandigarh@cioi .jaipur@cioins.co.
ns.co.in in
Office of the
Insurance Office of the
Ombudsman, Insurance
Fatima Akhtar Ombudsman,
Court, 4th Floor, 2nd Floor, Pulinat
453, Bldg.,
Anna Salai, Opp. Cochin
Tamil Nadu,
Teynampet, Shipyard, M. G.
Tamil Nadu Kerala,
CHENNAI – 600 Road,
CHENNAI PuducherryTown and Lakshadweep,
018. Ernakulam - 682
Karaikal (which are ERNAKULAM Mahe-a part of Union
Tel.: 044 - 015.
part of Puducherry). Territory of
24333668 / Tel.: 0484 -
24335284 Puducherry.
2358759 /
Fax: 044 - 2359338
24333664 Fax: 0484 -
Email: bimalokpal 2359336
.chennai@cioins.c Email: bimalokpal
o.in .ernakulam@cioin
Office of the s.co.in
Insurance Office of the
Ombudsman, Insurance
2/2 A, Universal Ombudsman,
Insurance Hindustan Bldg.
Building, Delhi & Annexe, 4th
Asaf Ali Road, Following Districts of Floor,
DELHI New Delhi – 110 Haryana - Gurugram, 4, C.R. Avenue,
002. Faridabad, Sonepat & West Bengal,
KOLKATA - 700
Tel.: 011 - Bahadurgarh. Sikkim,
KOLKATA 072.
23232481/232135 Andaman & Nicobar
Tel.: 033 -
04 Islands.
22124339 /
Email: bimalokpal 22124340
.delhi@cioins.co.i Fax : 033 -
n 22124341
Office of the Email: bimalokpal
Insurance .kolkata@cioins.c
Ombudsman, o.in
Jeevan Nivesh, Districts of Uttar
5th Floor, Pradesh :
Assam,
Nr. Panbazar over Lalitpur, Jhansi,
Meghalaya,
bridge, S.S. Road, Mahoba, Hamirpur,
Manipur,
GUWAHATI Guwahati – Office of the Banda, Chitrakoot,
Mizoram,
781001(ASSAM). Insurance Allahabad, Mirzapur,
Arunachal Pradesh,
Tel.: 0361 - Ombudsman, Sonbhabdra, Fatehpur,
Nagaland and Tripura.
2632204 / 6th Floor, Jeevan Pratapgarh,
2602205 Bhawan, Phase-II, Jaunpur,Varanasi,
Email: bimalokpal Nawal Kishore Gazipur, Jalaun,
.guwahati@cioins Road, Hazratganj, Kanpur, Lucknow,
.co.in Lucknow - 226 Unnao, Sitapur,
Office of the LUCKNOW 001. Lakhimpur, Bahraich,
Insurance Tel.: 0522 - Barabanki, Raebareli,
Ombudsman, 2231330 / Sravasti, Gonda,
6-2-46, 1st floor, 2231331 Faizabad, Amethi,
"Moin Court", Andhra Pradesh, Fax: 0522 - Kaushambi,
Lane Opp. Saleem Telangana, 2231310 Balrampur, Basti,
HYDERABAD Function Palace, Yanam and Email: bimalokpal Ambedkarnagar,
A. C. Guards, part of Union Territory .lucknow@cioins. Sultanpur,
Lakdi-Ka-Pool, of Puducherry. co.in Maharajgang,
Hyderabad - 500 Santkabirnagar,
004. Azamgarh,
Tel.: 040 - Kushinagar, Gorkhpur,
23312122 Deoria, Mau,

27 of 37
 Ghazipur, Chandauli, agents and intermediaries) or an insurance broker, on any of the
Ballia, Sidharathnagar. following grounds—
Office of the (a) delay in settlement of claims, beyond the time specified in the
Insurance regulations, framed under the Insurance Regulatory and
Ombudsman, Development Authority of India Act, 1999;
3rd Floor, Jeevan (b) any partial or total repudiation of claims by the life insurer,
Seva Annexe, general insurer or the health insurer;
S. V. Road, (c) disputes over Premium paid or payable in terms of insurance
Santacruz (W), Policy;
Goa, (d) misrepresentation of Policy terms and conditions at any time in
Mumbai - 400
Mumbai Metropolitan the Policy document or Policy contract;
054.
MUMBAI Region (e) legal construction of insurance policies in so far as the dispute
Tel.:
excluding Navi relates to claim;
69038821/23/24/2
Mumbai & Thane. (f) Policy servicing related grievances against insurers and their
5/26/27/28/28/29/
30/31 agents and intermediaries;
Fax: 022 - (g) issuance of life insurance Policy, general insurance Policy
26106052 including health insurance Policy which is not in conformity with
Email: bimalokpal the proposal form submitted by the proposer;
.mumbai@cioins. (h) non-issuance of insurance Policy after receipt of Premium in life
co.in insurance and general insurance including health insurance; and
State of Uttaranchal (i) any other matter arising from non-observance of or non-
and the following adherence to the provisions of any regulations made by the
Office of the Districts of Uttar Authority with regard to protection of policyholders’ interests or
Insurance Pradesh: otherwise, or of any circular, guideline or instruction issued by
Ombudsman, Agra, Aligarh, Bagpat, the Authority, or of the terms and conditions of the policy
Bhagwan Sahai Bareilly, Bijnor, contract, insofar as such matter relates to issues referred to in
Palace Budaun, Bulandshehar, clauses (a) to (h).
4th Floor, Main Etah, Kanooj,
Road, Mainpuri, Mathura, c. Manner in which complaint is to be made -
Naya Bans, Sector Meerut, Moradabad, 1) Any person who has a grievance against an insurer or insurance
15, Muzaffarnagar, broker, may himself or through his legal heirs, nominee or
NOIDA assignee, make a complaint in writing to the Insurance
Distt: Gautam Oraiyya, Pilibhit,
Buddh Nagar, Etawah, Farrukhabad, Ombudsman within whose territorial jurisdiction the branch or
U.P-201301. Firozbad, office of the insurer or the insurance broker, as the case may be,
Tel.: 0120- Gautambodhanagar, complained against or the residential address or place of
2514252 / Ghaziabad, Hardoi, residence of the complainant is located.
2514253 Shahjahanpur, Hapur, 2) The complaint shall be in writing, duly signed or made by way
Email: bimalokpal Shamli, Rampur, of electronic mail or online through the website of the Council
.noida@cioins.co. Kashganj, Sambhal, for Insurance Ombudsmen, by the complainant or through his
in Amroha, Hathras, legal heirs, nominee or assignee and shall state clearly the name
Kanshiramnagar, and address of the complainant, the name of the branch or office
Saharanpur. of the insurer against whom the complaint is made, the facts
giving rise to the complaint, supported by documents, the nature
Office of the
and extent of the loss caused to the complainant and the relief
Insurance
sought from the Insurance Ombudsman.
Ombudsman,
3) No complaint to the Insurance Ombudsman shall lie unless—
2nd Floor, Lalit
(a) the complainant has made a representation in writing or
Bhawan,
through electronic mail or online through website of the
PATNA Bailey Road, Bihar,
insurer or insurance broker concerned to the insurer or
Patna 800 001. Jharkhand.
insurance broker, as the case may be, named in the
Tel.: 0612-
complaint and—
2547068
i. either the insurer or insurance broker, as the case may
Email: bimalokpal
be, had rejected the complaint; or
.patna@cioins.co.i
ii. the complainant had not received any reply within a
n
period of one month after the insurer or insurance
Office of the broker, as the case may be, received his
Insurance representation; or
Ombudsman, iii. the complainant is not satisfied with the reply given
Jeevan Darshan to him by the insurer or insurance broker, as the case
Bldg., 3rd Floor, may be;
C.T.S. No.s. 195 Maharashtra, (b) The complaint is made within one year—
to 198, Area of Navi Mumbai i. after the order of the insurer or insurance broker, as
PUNE N.C. Kelkar Road, and Thane the case may be, rejecting the representation is
Narayan Peth, excluding Mumbai received; or
Pune – 411 030. Metropolitan Region. ii. after receipt of decision of the insurer or insurance
Tel.: 020- broker, as the case may be, which is not to the
41312555 satisfaction of the complainant;
Email: bimalokpal iii. after expiry of a period of one month from the date of
.pune@cioins.co.i sending the written representation to the insurer or
n insurance broker, as the case may be, if the insurer
named fails to furnish reply to the complainant.
4) The Ombudsman shall be empowered to condone the delay in
such cases as he may consider necessary, after calling for
objections of the insurer or insurance broker, as the case may be,
against the proposed condonation and after recording reasons for
condoning the delay and in case the delay is condoned, the date
b. Insurance Ombudsman- of condonation of delay shall be deemed to be the date of filing
1) The Ombudsman shall receive and consider complaints alleging of the complaint, for further proceedings under these rules.
deficiency in performance required of an insurer (including its 5) No complaint before the Insurance Ombudsman shall be
maintainable on the same subject matter on which proceedings

28 of 37
 are pending before or disposed of by any court or consumer
forum or arbitrator.
6) The Council for Insurance Ombudsmen shall develop a
complaints management system, which shall include an online
platform developed for the purpose of online submission and
tracking of the status of complaints made under rule 14 of
Insurance Ombudsman Rules, 2017.

29 of 37
 PROPOSAL FORM/ELECTRONIC PROPOSAL
FORM FOR SINGLE/JOINT LIFE
Linked and Non Linked Individual Life Plans with Declaration of Good Health

For Office use only

Consultant Name & Code: NAVEEN KUMARSAHANI 01160341
License No: License Expiry Dt: Bancassurance Code:
Company Lead: Lead Reference No: 1-195564652803 Channel Partner Cust Id:
IA / CAO Emp No: IA / CAO Name: Branch Code:
Channel Code: FOS Code: Telecode:

ALL UNIT LINKED POLICIES ARE DIFFERENT FROM TRADITIONAL INSURANCE POLICIES AND ARE SUBJECT TO DIFFERENT RISK FACTORS.
IN UNIT LINKED POLICY THE INVESTMENT RISK IN YOUR CHOSEN INVESTMENT PORTFOLIO IS BORNE BY YOU Photograph of life to be assured*
to be signed across by the life to
be assured
* Not mandatory if life to be
assured is different from the
1) The entire form is to be filled in black ink only by the policyholder. Use CAPITAL letters for information required in boxes with a space between Proposer except if Life to be
assured is minor
words. 2) Any cancellation / alteration is to be signed by the proposed policyholder or life to be assured as appropriate. 3) All information provided here
shall be relied on and should be accurate, complete and true in all respects for processing the proposal quickly. In case you have any doubt whether the
particular information is material or not, please disclose the information. 4) Please attach an extra sheet, wherever additional information is to be given.

Proposer (Primary Life to be Assured)/ Policy Owner Details (Proposer in case of Click 2 Wealth for Premium Waiver Option)
1. Full Name:(Leave a blank space Ms. POOJA RANA
between First, Middle & Last Name)
2. Maiden Name:(for married woman only) JI
3. Date of Birth (DD/MM/YYYY): 09/12/1990
4. Gender(M/F/Tg): Female
5. Marital Status: Married
6. Nationality: Indian
7. Education: SSC
8. Resident status: Resident Indian
If you are NRI/PIO/OCI, Please attach appropriate
Questionnaire.

Country of Residence:
If NRI/PIO/OCI

Country of Workplace:
If NRI/PIO/OCI

Permanent Country:
9. If you are our existing life NA
assured, assignee, nominee,
proposers kindly enter Policy
No./Customer ID:
10. Correspondence A-485,STREET NO 16,PART-4, ZERO PUSTA,SONIA VIHAR SABHAPU, ASHRAM
Address: KSHETRA Delhi, Delhi-110094 India
11. Permanent Address (If A-485,STREET NO 16,PART-4, ZERO PUSTA,SONIA VIHAR SABHAPU, ASHRAM
different from KSHETRA Delhi, Delhi-110094 India
correspondence address)/
Overseas residential
address for NRI / PIO / OCI :
12. Mobile: 918130180514
Telephone No(R):
Telephone No(O):
E - mail ID: MAANSINGHRAJPUT1988@REDIFFMAIL.COM
Email ID if provided, will be
considered as preferred mode of
communication

13. Preferred language of English

communication:
14. Present Occupation: Housewife
Gross Yearly Income
(INR):
Workplace Name and
Address:
^ if Retired, please provide name of
last organisation

Industry Type (cement,

baking, etc.):
Exact Nature of work
(clerical, mechanical,
supervisory job, etc.):
Nature of Occupation
(architect, etc.):
15. Income Proof (proposer): Identity Proof (Proposer):
Address Proof Age Proof (Life Assured):
(Proposer):
PAN* (Proposer):
16. PAN Photocopy
enclosed :(*Submit Form 60 if PAN
is not available)

17. Do you want policy in No E insurance account number:

Demat form?If a policy is requested
in demat form, it will not be given in
physical form and vise versa.

18. Is the Policy holder same Yes

as Life Assured
Relationship with Life to Self
be Assured
19. Are you taking the policy No 30 of 37
to primarily protect the
disabled person?
20. Are you a "Politically No
Exposed Person"?
Definition of a Politically Exposed Person: Politically exposed persons are individuals who are or have been entrusted with prominent public functions in a foreign country, their family members
and close relatives; for e.g. Heads of States or of Governments, Senior politicians, Senior government / judicial / military officers,Senior executives of state-owned corporations, Important
politicals party officials, etc.

21. Do you have any history of conviction / acquittal under any criminal proceedings in India or abroad? No
22. Sources of Funds: If Premium & Single Premium Top-ups, if any is equal to or more than INR 1 lakh, please enclose proof of income e.g. ITR

Salaries Business House Property Capital Gains Investments Agriculture Others Total
100% 100%

Details of Secondary Life to be Assured (Life Assured in case of Click 2 Wealth for Premium Waiver Option)
1. Full Name: (Leave a blank space Ms. POOJA RANA
between First, Middle & Last Name)
2. Maiden Name:(for married woman only) JI
3. Father/Husband Name:
4. Mother's Maiden Name:
5. Relationship with Primary Life Assured:
6. Date of Birth (DD/MM/YYYY) : 09/12/1990
7. Gender(M/F/Tg): Female
8. Marital Status: Married
9. Nationality: Indian
10. Education: SSC
11. Resident status: Resident Indian
If you are NRI/PIO/OCI, Please attach appropriate
Questionnaire.

Country of Residence:
If you are NRI/PIO/OCI

Country of Workplace:
If you are NRI/PIO/OCI

Permanent Country:
12. Present Occupation:
13. Gross Yearly Income (INR):
14. Workplace Name and Address:
^ please provide name of last organisation

15. Industry Type (cement, baking, etc.):

16. Exact Nature of work (clerical,
mechanical, supervisory job, etc.):
17. Nature of Occupation (architect, etc.):
18. Do you have any history of conviction / acquittal under any criminal proceedings in India or abroad? No
19. If Life to Assured is a student/housewife, please provide insurance details regarding parents/husband/siblings.
(Please attach a separate sheet for multiple policies if required.)

Total Sum Assured of all inforce life Policy No. and Name of Company Husband's / Parent's Occupation /
insurance policies Income

Declaration of good health of Primary Life to be Assured/Policy Holder

I hereby declare that, as of the date of this declaration, I/We do not have any history of, have never suffered from or currently suffering from medical conditions such as, but not limited
to, high blood pressure, chest pain, heart attack or any other heart condition; stroke, transient ischemic attack or any other cerebrovascular disease; diabetes or any other endocrinal
disease; kidney disease; HIV / AIDS or AIDS related complex; any cancer or tumor; asthma or any other respiratory disease; any mental or nervous disease; hepatitis or any other liver
disease; blood disorders; digestive and bowel disorders; paraplegia, physical disability or any other disorder of the bones, spine or muscle; any other disease, disorder or disability, not
mentioned above and excluding minor impairment such as common cough or cold. I/We have never undergone or expect to undergo any surgical procedure for any illness, ailment,
disease or disability which is affecting my day to day activities. In the last 5 years, I/We have not received any form of medication for more than 7 consecutive days or been absent
from work for more than 7 days.
I further declare that, as of the date of this declaration, I/We do not engage or intend to engage in any business, sport or occupation of a hazardous nature.

c. For Female Lives: I/We further declare that presently I/We am/are not pregnant or I/We do not have a history in the past of an abortion, miscarriage or caesarean section due to
complications during pregnancy or due to any other cause, I/We have not given birth to a child with any congenital disorder such as Down Syndrome, congenital heart disease, etc and
I/We have not ever had any disease of breast, uterus, cervix, ovaries or any other part of the reproductive system.
d. I/We further declare that, as of the date of this declaration, I/We do not engage or intend to engage in any business, sport or occupation of a hazardous nature. I declare that, I/We
do not have any history of conviction under any criminal proceedings in India or abroad.

Important Note: Any false declaration may be liable for rejection of the proposal form and the contract of insurance shall be treated null & void. It may also lead to rejection of the claim
on death of the life assured.

Date:________________________ Place:_______________________________ Signature of Primary Life to be Assured/Policy Holder

Nominee Details (To be filled only if Proposer and Life to be assured are same)
Nominee Full Name Date of Birth(DD/ Gender(M/F/Tg) Relationship Contact No % Share
MM/YYYY) with Life to be
Assured
1 Mr. MAAN SINGH 04/08/1988 Male Husband 100

Details of Products Applied For

1. Objective of Savings
Insurance:
2. Mode :(for regular / limited Annual
premium paying plan)

3. Premium Payment Limited Pay

Option:
4. Top-up Option: No ________Top up % (available only under Click 2
Protect 3D Plus )

5a. Product Details:

Product Name Cover type Plan Option Policy Term Premium Sum Modal
(Self/PPH/HUF/ (in years) Payment Assured(in Premium (in
MWPA/Business)
Term(in years) INR) INR) 31 of 37
HDFC Life Sanchay Fixed 15 7 4,05,768 30,000
Maturity Plan
6a. For YoungStar
Udaan, Classic Waiver
Plan Option:
6b. For YoungStar
Super Premium, also
choose Benefit Option:
6c. For Sampoorn
Nivesh, also choose
Benefit Option :
6d. For Classic One,
choose Coverage
Variant :
6e. For Click 2 Wealth,
choose plan option :
6f. For Sanchay
Plus,choose Income
Payout Mode :
6g. For Sanchay Par
Advantage, choose
survival benefit payout
option :
6h. For Sanchay Par
Advantage, also choose
survival benefit payout
frequency :
6i. For Sanchay Par
Advantage, also choose
survival benefit payout
date :
6j. For Click 2 Protect Return of Premium: WoP CI: Accidental Death
Life, choose add on Benefit:
option :
7. Rider Details: Product Rider Name Coverage Rider Option Rider Policy Rider Premium Pay Term(in Rider Sum Modal
(with additional premium) Name Type Term(in years) years) Assured(in Premium (in
INR) INR)

HDFC Life HDFC Life 7 7 1,00,000 112

Sanchay Critical
Fixed Illness Plus
Maturity Plan Rider
8. Top-up Premium NIL Top-up Sum Assured NIL Total Premium (INR): 31,482
(INR): (INR):
9. Commencement Backdation Charges
date^: (INR) (if any):
(^only for non linked plan - Has to be within
the same financial year)

10.I wish to opt for Systematic Transfer Plan (STP) No

Source Fund Target Fund Amount Transfer Date

In case the Transfer Date is not selected, it will be consider

as 1st of the Month.
In order to activate/continue STP, Policyholder has to ensure
that sufficient premiums are allocated in Source Fund.

11. For unit linked plans, kindly indicate % of allocation in below mentioned funds as applicable (please check the fund for the product applied)
Income Balanced Blue chip Opportuni Equity Diversified Bond Conservat Liquid Discovery Equity Bond Plus Secure Sustaina Total(%)
Fund Fund Fund ties Fund Plus Fund Equity Fund ive Fund Fund Fund Advantage Fund Advantage ble Equity
Fund Fund Fund Fund
% % % % % % % % % % % % % % 100(%)

Details of First Premium Deposit.

Payor Details: Self
Payment Details: Amount in (INR): 31,482
Drawn on (Bank name & branch): ______________________
Cheque / DD No. ______________________ Date: ______________________ Bank A/c No. ______________________

Payout Mode(Choose any one)

Selected mode would be used by the company to make payout(s) to the Proposer. Payout would be in accordance and subject to the terms and conditions of the policy.

1 Account Type: Savings 2 Bank Name: INDIAN BANK

3 Account Number: 6145732561 4 Bank Branch: INDIAN BANK Sector83Noida
5 IFSC Code: IDIB000S216

Declaration: 1. In case of non credit to my bank account with/without assigning any reasons there of or if the transaction is delayed or not effected at all for reasons of incomplete / incorrect information, I would not hold HDFC Life Insurance Co. Ltd
responsible. 2. In case of NRI/NRE account, cheque will be issued.

Note: Please provide a cancelled copy of your cheque.

Signature of Proposer

Declaration of the Life(s) to be Assured and Proposer / Policy Owner

I/We declare that:

i.I/We have replied to the questions, and have made the statements in respect of the matters sought for, in the proposal Form/Electronic proposal form ("Proposal Form") and I
understand and agree that the replies given and statements/declarations made in the Proposal Form together with any documents submitted by me/us for processing my/our
application for insurance shall be the basis of the contract between me/us and HDFC Life Insurance Company Limited ("the Company"). All documents submitted by me/us along with
this Proposal Form are authentic, valid, and where relevant true copies of originals for the purpose of this Proposal Form have been submitted and I/ we have not withheld any material
fact within my/ our knowledge. ii. I/We understand and agree that in case of misstatement or suppression of material facts the policy contract shall be treated in accordance with the
Sec 45 of Insurance Act,1938 as amended from time to time. iii.I/We shall be bound to notify the Company forthwith, in writing, of any change in my/our health, occupation or income
between the date of this Proposal Form and the date of acceptance of my/our proposal for insurance, as communicated in writing to me/us by the Company. iv. I/We have deposited
the first premium along with this Proposal Form, and the premiums payable under the Policy that may be issued in pursuance of this proposal for insurance, will be paid, strictly in
accordance with the law of the land. Amounts paid, otherwise than from my account shall be paid only if i/we can establish an insurable interest. v. All/any amounts paid/payable
towards the policy will be out of legally declared and assessed sources. Further,all the premiums will be paid in accordance with Prevention of Money Laundering Act 2002 (as
amended from time to time) or any other applicable laws.vi. I/we will provide information as required by the Company, on its own or under any lawful instruction/ order, regarding 32 of 37
sources of funds/utilization/ withdrawals.
i.That the Company
I/We agree will be on risk in pursuance of this proposal for insurance only after the risk under the Proposal Form is accepted by the Company and such acceptance is
and understand:
communicated to me/us in writing by the Company. ii.That the Company has the right either to accept or reject my/ our proposal without giving reasons thereto and I undertake that
there shall be no costs, claims, charges being raised by me/ us against the Company thereof. iii. That the Company shall be entitled to retain the premium paid along with the Proposal
Form as an interest free initial deposit to be adjusted against premium payable upon issuance of the Policy. In the event the proposal for insurance is not accepted by the Company the
aforesaid deposit shall be refunded without any interest subject to deductions for medical costs, if any. iv. That the premium payable as well as the sum assured (main as well as
additional benefits) may vary upon assessment of risk by the Company. v.That the Company may seek information from any of my/ our past or present employers/ business associates
or from a doctor/medical examiner / hospital / laboratory / clinic who at any time have attended to me/ us concerning anything which affects my/ our physical or mental health or may
seek information from any insurance office to which an application has been made for insurance on my/ our life. I/ We hereby authorize such parties to furnish information as required
by the Company and also to furnish any documents regarding my/ our employment/business, my/ our health and habits or health and habits of the Life to be Assured (without taking
the prior consent of my/ our family or of any member thereof) as it may require either for the purpose of processing my/ our proposal for insurance or at any time thereafter for any
other purpose in relation to the Policy that may be issued in pursuance of this proposal for insurance vi.In the event of I/we being medically examined, the answers given by me/ us to
the medical examiner acting on behalf of the Company shall be deemed to be incorporated in this proposal for insurance.vii. That the Company may, without any reference to me/us or
my family or any member thereof, furnish any details/ information furnished in this Proposal Form to any judicial or statutory or other authority or to any insurer or reinsurer in
connection with the processing of this proposal for insurance or servicing of this policy. viii. That the Company may contact/ communicate with me/us through postal or courier service,
email, telephone, mobile, sms or VoIP including Whats App. ix. I hereby declare and agree that the above disclosures along with the Statements and the declarations made under the
proposal made by me as Proposer and on behalf of the other/secondary life assured in case of joint life proposals will be the basis of the contract of assurance between us and HDFC
Life. If any statement is found to be untrue or inaccurate or if any fact that might influence the terms of acceptance of this proposal is not disclosed by me in my capacity as Proposer
and on behalf of the other/secondary life assured in case of joint life proposals, the contract shall be treated in accordance with the Sec 45 of Insurance Act,1938 as amended from
time to time.x. That I/We have voluntarily given my/our consent to collect, process, receive, possess, store, deal or handle my/our sensitive personal data or information [as defined in
the Information Technology (Reasonable security practices and procedures and sensitive personal data or information) Rules 2011 as amended from time to time], with third parties/
vendors associated with the Company for various purposes and outsourced activities related to issuance/servicing/settlement of claim as required under the Policy.

Additional Declaration (Applicable for Health Rider / Product):

i. I/We hereby declare, on my/our behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me/us are true and
complete in all respects to the best of my/ our knowledge and that I/ We am/are authorised to propose on behalf of these other persons. ii. I/We understand that the information
provided by me / us will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurer and that the policy will come into force only after full
payment of the premium chargeable.iii. I/We further declare that I / We will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer
after the proposal has been submitted but before communication of the risk acceptance by the company. iv. I/We declare that I/We consent to the company seeking medical
information from any doctor or hospital who/which at any time has attended on the person to be insured/proposer or from any past or present employer concerning anything which
affects the physical or mental health of the person to be insured/proposer and seeking information from any insurer to whom an application for insurance on the person to be insured /
proposer has been made for the purpose of underwriting the proposal and/or claim settlement. v. I/We authorize the company to share information pertaining to my/our proposal
including the medical records of the insured/proposer for the sole purpose of underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory
authority.

Signature/Thumb impression of (Primary) life to be assured. Signature should match with signature on ECS/SI mandate

Date: Place:

Mobile:

PLEASE DO NOT SIGN ON THE BLANK PROPOSAL FORM

Declaration of good health for spouse

Name: DOB: Amount of Insurance:

Within the past 5 years from the date of signing this proposal form, I have neither been hospitalized for, required medication or treatment for, nor consulted a
physician (to include a follow-up visit) due to, or as a result of, any of the following: alcohol or drug abuse, heart or circulatory disorder, stroke, cancer or
leukemia, diabetes, high blood pressure, chronic kidney or liver disease, mental, nervous or neurological disorders, lung disorders, AIDS (acquired immune
deficiency syndrome), ARC (AIDS related complex), or had tests indicating exposure to the AIDS virus.

Yes No Date:____________________ Signature of the spouse

Declaration (If signed in Vernacular language / Thumb impression has been affixed above)

Declaration to be made by a 3rd person where: The life(s) to be assured/proposed policyholder has affixed his/her thumb impression; OR the life to be assured/proposed
policyholder has signed in vernacular; OR the life to be assured/proposed policyholder has not filled the application OR/AND The spouse of the life to be assured/
proposed policyholder has affixed his/her thumb impression or signed in vernacular the Declaration of Good Health applicable under Elite Option of Smart Woman Plan.

I hereby declare that I have explained the contents of this application form to the life to be assured / proposed policyholder in ________________________language and have
truthfully recorded the answers provided to me. I further declare that the life to be assured/proposed policyholder has signed/affixed his/ her thumb impression in my presence.

____________________________________________________________________________________________________ ___________________________________
Name and address of Declarant Signature of Declarant
Occupation of the Declarant
Name and address of Witness Signature of Witness
Occupation of the Witness

Declaration made by life to be assured/proposed policyholder

I/We certify that the contents of the form have been fully explained to me by Mr. / Mrs.:________________________________

_____________________________________________________________________ ______________________________________
Signature/Thumb impression of life to be assured/proposed policyholder Name, Designation & Occupation

Sections of the Insurance Act 1938 as amended from time to time

Section 41 - Prohibition of rebates: (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or continue an insurance
in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall
any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the
insurer. (2) Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.

Section 45 - 1.No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the policy, i.e., from the date of 33 of 37
issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later. 2. A policy of life insurance may be
called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to
the policy, whichever is later, on the ground of fraud: Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or
assignees of the insured the grounds and materials on which such decision is based. 3.Notwithstanding anything contained in sub-section (2), no insurer shall repudiate a life
insurance policy on the ground of fraud if the insured can prove that the misstatement of or suppression of a material fact was true to the best of his knowledge and belief or that there
was no deliberate intention to suppress the fact or that such mis-statement of or suppression of a material fact are within the knowledge of the insurer: Provided that in case of fraud,
the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive. 4.A policy of life insurance may be called in question at any time within three years from the date
of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground that any
statement of or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of which the policy was
issued or revived or rider issued: Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the
grounds and materials on which such decision to repudiate the policy of life insurance is based: Provided further that in case of repudiation of the policy on the ground of misstatement
or suppression of a material fact, and not on the ground of fraud, the premiums collected on the policy till the date of repudiation shall be paid to the insured or the legal representatives
or nominees or assignees of the insured within a period of ninety days from the date of such repudiation. 5. Nothing in this section shall prevent the insurer from calling for proof of age
at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the
life insured was incorrectly stated in the proposal.

34 of 37
 26-05-2022

Quote No : qb61s5j2jv0ke,Application No : 1100073123954

Benefit Illustration for HDFC Life Sanchay Fixed Maturity Plan

This Illustration has been produced by HDFC Life Insurance Company Limited to help you understand the benefits of your
HDFC Life Sanchay Fixed Maturity Plan
DETAILS
Name of the Prospect/Policyholder: POOJA RANA Proposal No: NA
Age: 31 Name of Product: HDFC Life Sanchay Fixed Maturity Plan
A Non-Linked,Non-
Name of Life Assured 1: POOJA RANA Tag Line: Participating,Individual,Savings,Life
Insurance Plan
Age: 31 Unique Identification No: 101N142V01
Sex: F GST Rate: 4.5% for first year
Policy Term: 15 2.25% second year onwards
Premium Paying Term: 7
Amount of Instalment Premium
Rs.30000
(Without GST):

Mode of Payment of Premium: Annual

This benefit illustration is intended to show year-wise premiums payable and benefits under the policy.

Policy Details

Policy Option Single Life

Death Benefit(at
Sum Assured on Maturity 300000
405768 inception of the policy) Rs.
Rs.

Rider Details

Rider Name Rider UIN Rider PPT Rider PT Rider Sum Assured Rs.

HDFC Life Critical Illness Plus Rider 101B014V02 7 Years 7 Years 100000

35 of 37
 Premium Summary

PP PP Total
Base Plan CI Rider IB Rider PP Rider (PAC) Rider Rider Instalment
(ADC) (CC) Premium

Instalment Premium without GST 30,000 112 0 0 0 0 30,112

Instalment Premium with First Year GST 31,350 132 0 0 0 0 31,482

Instalment Premium with GST 2nd Year Onwards 30,675 132 0 0 0 0 30,807

36 of 37
 (Amount in Rupees)
Policy Year Single/ Guaranteed Non-Guaranteed
Annualized
Survival Benefits / Other benefits Maturity Benefit Death Benefit Min Special Surrender Value
Premium
Loyalty Additions (if any) Guaranteed
Surrender
Value

1 30000 0 0 0 300000 0 0

2 30000 0 0 0 300000 18000 18000

3 30000 0 0 0 300000 31500 31500

4 30000 0 0 0 300000 60000 87623

5 30000 0 0 0 300000 75000 119644

6 30000 0 0 0 300000 90000 156858

7 30000 0 0 0 300000 105000 199962

8 0 0 0 0 300000 117600 218425

9 0 0 0 0 300000 128100 238632

10 0 0 0 0 300000 140700 260706

11 0 0 0 0 300000 153300 284849

12 0 0 0 0 311183 165900 311183

13 0 0 0 0 339952 176400 339952

14 0 0 0 0 371399 189000 371399

15 0 0 0 405768 405768 0 0

Notes:
1. Annualized Premium excludes underwriting extra premium, frequency loadings on premiums, the premiums paid towards the riders, if any, and Goods & Service Tax. Refer Sales
Literature for explanation of terms used in this illustration.
2. The maturity benefit is payable at the end of the policy year. Upon payment of the maturity benefit, the policy terminates and no further benefits become payable.
3. The death benefits shown above are at the end of the year. Upon payment, of death benefit the policy terminates and no further benefit is payable.
4. The surrender benefits shown above are at the end of the year. Upon payment of surrender benefit, the policy terminates and no further benefit becomes payable.
5. The Premium and the Sum Assured on Maturity stated above is based on the information provided. They may vary as a result of underwriting.
6. Any statutory levy or charges (such as Goods and Service tax) including any indirect tax may be charged to the Policyholder either now or in future by the company and such
amount so charged shall become due and payable and shall be subject to the same terms and conditions as applicable to payment of premium.

I NAVEEN KUMAR SAHANI, have explained the premiums and benefits under the I POOJA RANA,having received the information with respect to the above, have
policy fully to the prospect / policyholder. understood the above statement before entering into the contract.

Place:

Date: Signature of Agent /Intermediary / Official Date: Signature of Prospect / Policyholder

37 of 37